Medical Biller; Bilingual

Position: Medical Biller (Bilingual)
Position Title:

Medical Biller

Reports to:

Revenue Cycle Manager

Primary

Location:

Georgetown - (incumbent may be transferred or asked to report to any of LRHC's locations based on the needs of the organization)

Wage Classification:
Non-Exempt

Job Summary:

The Medical Biller is responsible for timely and accurate billing, payment posting, denial management, and follow-up for all payer types within an FQHC setting. This position supports the financial health of the organization by ensuring claims are submitted, tracked, and resolved efficiently, while adhering to FQHC regulations, sliding fee scale policies, and productivity standards established by the Revenue Cycle Manager

Essential Responsibilities:

The following duties are not intended to serve as a comprehensive list of all duties performed by all associates in this position. The duties listed are intended to provide a representative summary of the major duties and responsibilities. The incumbent may be required to perform additional, position-specific duties as assigned by their manager and/or LRHC Leadership.

* Submits medical claims electronically to all payors, including Medicaid, Medicare, commercial insurance, and managed care plans

* Works assigned Denial & Aging reports provided by the Revenue Cycle Manager in a timely manner.

* Works daily in the clearinghouse to review, correct, and resubmit rejected or scrubbed claims

* Posts payments, adjustments, and denials accurately and timely

* Identifies, research, and resolve claim denials; take appropriate corrective action to ensure timely reimbursement

* Prepares and submit appeals with required documentation within payer deadlines

* Manages and work self-pay balances, including application of the sliding fee scale in accordance with FQHC guidelines

* Monitors aging accounts and follow up on unpaid or underpaid claims

* Notifies the Revenue Cycle Manager of trends, issues, or payer-related problems that may negatively impact revenue

* Ensures compliance with federal, state, and payer billing regulations specific to FQHCs

* Maintain accurate documentation in the billing system and patient accounts

* Meet or exceed productivity and quality standards established by the Revenue Cycle Manager

* Participate in audits, payer reviews, and process improvement initiatives as needed

* Perform other revenue cycle-related duties as assigned

* Investigate and work patient and/or insurance credits

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or competency required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

* 2-3 years' experience in patient access, medical billing, social services preferably in a community health setting.

* Familiarity with Medicaid, Medicare, and the Affordable Care Act (ACA) marketplace

* Proficiency in interpreting Sliding Fee Scales (a hallmark of FQHCs) and understanding HIPAA privacy guidelines

Education and/or

Experience:

* High School Diploma or GED required.

Language

Skills:

English proficiency

Skills and

Competencies:

* Strong knowledge of FQHC billing requirements, including PPS, wraparound claims, and sliding fee scale application

* Proficiency in claim submission, denial resolution, and appeals processes

* Ability to analyze billing data, identify root causes, and recommend solutions

* Experience working with electronic health record (EHR) and practice management systems

* Familiarity with clearinghouse workflows

* Strong attention to detail, accuracy, and organization

* Ability to work independently while managing multiple priorities and deadlines

* Strong written and verbal communication skills

Equipment Operated:

Wide range of office equipment. Computer use and proficiency required.

Mental/

Physical Requirements:

* Sitting for long periods while using a computer

* Ability to focus for sustained periods with minimal supervision