Medical Biller

**Summary**

**Compensation**

**₹45,000 to ₹70,000 per month** (based on experience and specialty expertise)

**Key ResponsibilitiesMedical Coding & Compliance**
- Accurately assign CPT, ICD-10, and HCPCS codes based on provider documentation.
- Ensure coding aligns with specialty-specific payer guidelines and documentation requirements.
- Collaborate with billing and clinical teams to resolve coding-related queries or discrepancies.
- Maintain up-to-date knowledge of coding standards, modifiers, NCCI edits, and payer-specific rules.

**Specialty Care Expertise**
- Code and bill for procedures and services in two or more of the following specialties:

- **Cardiology**:

- **Pulmonary**:

- **Sleep Medicine**:

- **ENT**:

- **Gastroenterology (GI)**:

- **Neurology**:

- **Internal Medicine** (only if procedure-heavy practice)
- **Chronic Care Management (CCM) / Remote Patient Monitoring (RPM)**:

- **Rheumatology** (only if experience is from a procedure-heavy setting)

**Please Note**:

- Only Infectious Disease or Nephrology
- Only Mental Health
- Only General Surgery without specialty-specific exposure

**Claims Processing & Revenue Cycle Management**
- Submit accurate and timely claims to insurance companies, including Medicare, Medicaid, and commercial payers.
- Review claims for accuracy, ensuring proper coding and compliance with payer guidelines.
- Monitor and track submitted claims, identifying and correcting errors before submission.
- Work closely with providers and staff to obtain necessary documentation for billing and reimbursement.

**Accounts Receivable (AR) & Denial Management**
- Monitor and manage AR to ensure timely reimbursements from insurance companies and patients.
- Follow up on unpaid or underpaid claims, ensuring timely resolution.
- Investigate and resolve denied or rejected claims, submitting appeals as necessary.
- Identify trends in denials and recommend process improvements to minimize future rejections.
- Communicate with payers to clarify coverage, reimbursement rates, and claim status.
- Work with the front office and collections team to improve financial recovery and reduce outstanding balances.

**Payment Posting & Patient Billing**
- Post payments from insurance companies and patients into the billing system, ensuring accuracy.
- Generate and send patient statements, ensuring clear and transparent billing details.
- Assist patients in understanding their bills, insurance coverage, and payment options.
- Work with the Front Office team to ensure proper patient collections at the time of service.

**Denial Prevention & Revenue Optimization**
- Identify and address coding-related issues that may result in denials or delays in reimbursement.
- Proactively support clean claim rates through accurate and compliant coding practices.
- Participate in regular audits and provide feedback for continuous improvement.

**Documentation Review & Provider Support**
- Review clinical documentation for completeness and accuracy to support code selection.
- Communicate with providers when clarification or additional documentation is needed.
- Support training and education efforts related to documentation improvement.

**Compliance & Documentation**
- Maintain up-to-date knowledge of CPT, ICD-10, and HCPCS codes relevant to specialty care.
- Ensure billing compliance with HIPAA, CMS, and insurance guidelines.
- Keep detailed records of billing activities, correspondence, and account adjustments.
- Assist in preparing reports and financial statements related to billing, collections, and AR aging.

**Collaboration & Process Improvement**
- Work closely with Providers, the Front Office, Referral Coordinator, and DME team to ensure accurate charge capture.
- Assist in transitioning from the third-party billing service to the in-house team, identifying and resolving process gaps.
- Provide feedback and suggestions to improve efficiency and accuracy in billing workflows.
- Stay updated on industry trends, policy changes, and payer-specific guidelines.

**Qualifications & Skills**
- Minimum **5 years of US medical billing and coding experience**, specifically in specialty care.
- Must have **coded and billed for at least two of the specified specialties** listed above.
- Strong working knowledge of **CPT, ICD-10, and HCPCS** codes.
- Familiarity with payer-specific coding and billing rules, insurance guidelines, and compliance standards.
- Experience in **AR follow-ups, denial resolution, collections**, and **reimbursement optimization**.
- Proficiency in medical billing software and Electronic Health Records (EHR).
- Excellent **analytical and problem-solving** skills.
- High attention to detail and commitment to **accuracy and compliance**.
- Strong **communication skills** for cross-team collaboration, provider engagement, and patient interactions.
- Ability to work **independently and meet deadlines** in a remote environment.

**Schedule & Work Environment**
- Full-time, **remote** position