Certified Professional Medical Biller

Overview

Job Title: Certified Professional Medical Biller

Position Summary:

We are seeking an experienced Certified Professional Medical Biller with extensive expertise in medical billing and revenue cycle management for multi-specialty healthcare facilities. This position will report to and be supervised by our Medical Biller Manager. The ideal candidate will handle both facility and professional claims, including reimbursement, posting, work comp and personal injury cases, appeals, and settlement negotiation under the Illinois Lien Act.

This role requires strong knowledge of insurance billing, coding, and practice management tasks, with a proven ability to optimize revenue collection and manage denied claims.

• Manage the full medical billing cycle for facility and professional services, including claims submission, posting, and reconciliation.
• Handle Work Comp and personal injury cases, including electronic claim submission, follow-ups with insurance companies, and coordination with attorneys.
• Negotiate settlements under the Illinois Lien Act.
• Conduct appeals and manage denied claims to ensure maximum reimbursement.
• Verify provider credentials, manage referrals, and handle pre-certifications for procedures.
• Oversee billing for specialties including Physical Therapy, Pain Management, Chiropractic, and Surgical services.
• Maintain accurate records and ensure compliance with HIPAA and all applicable regulations.

• Certified Professional Biller with demonstrated experience in medical billing and coding.
• Thorough understanding of ICD-10 and CPT coding, UB-04 claim forms, and electronic claims submission.
• Hands-on experience with cloud-based and on-premise billing solutions such as Athena, eCW (eClinical
  
  Works), SIS.
• Strong knowledge of revenue cycle management and collection of denied claims.
• Experience in credential verification, referrals, pre-certifications, and practice management tasks.
• Ability to manage multiple priorities in a fast-paced healthcare environment.

• Medical billing for multi-specialty practices and multiple payers.
• Work Comp and personal injury claims management.
• Appeals, denial management, and Illinois Lien Act settlement negotiation.
• EMR management and electronic claim submission.
• Strong organizational, communication, and problem-solving skills.