Medical Biller II

Job Summary

Medical billers bill all patient accounts to the appropriate insurance company or payor in an efficient, accurate and timely manner according to payor regulations, and, as appropriate, provide assistance in regard to patient bills, customers (patients, families, physician offices, review organizations, insurance companies) in a polite and professional manner. The essential functions are subject to change based on organizational needs and to ensure adaptability to the ever‑changing environment of healthcare.

• Consistently demonstrates AIDET
• Obtains appropriate insurance and demographic information
• Understands EOBs, billing ticket statuses, and takes appropriate actions accordingly
• Understands claim edits for claim processing and takes appropriate action accordingly
• Enters quality financial notes into the EMR whenever an action is taken related to an account
• Processes Facility & Professional claims
• Protects patient rights by maintaining strict confidentiality, respecting HIPAA
• Answers incoming phone calls from patients and insurance carriers
• Retrieves and returns phone calls
• Processes primary, secondary, and tertiary insurance
• Follows up on insurance requests and accounts receivable
• Verifies eligibility websites and benefits
• Reviews authorizations and denials
• Submits coding requests to coding department
• Communicates with coding department for clarification when needed
• Proficient in utilizing insurance websites
• Follows up on ageing accounts with insurance companies for payment
• Maintains accurate and complete patient accounts
• Voids/clones tickets when appropriate
• Cross‑trained to other insurances to cover for coverage gaps
• Creates refunds to the appropriate party
• Completes appeals to insurance companies
• Prepares insurance follow‑up reports and electronic queue status
• Other duties as assigned

None

• Proficiency in Microsoft Excel, email composition, business correspondence, and general office skills is required.
• Knowledge of basic office functions, including message‑taking, cash drawer balancing, and data entry.
• Strong attention to detail, ability to follow directions, and excellent customer service skills in an office environment.
• Experience in an office setting and/or medical billing experience.

• Exceptional customer service, written and verbal communication skills.
• Positive attitude and commitment to the organization’s values and behavioral standards.
• Ability to work collaboratively, exceed expectations, and maintain a professional demeanor.
• Strong problem‑solving and critical thinking skills.
• Proficiency with computer systems and multi‑line phone systems.
• Adaptability to changing workflows and situations.

• Education or experience in medical office work, referrals, or billing strongly preferred.

Address all assessments and actions required by the organization’s clinical and compliance policies.

This role serves diverse populations, including neonatal, pediatric, adolescent, adult, and geriatric patients, as well as individuals of varying genders, races, ethnicities, abilities, and socioeconomic backgrounds.

• Fast‑paced office environment requiring multitasking and prioritization.
• Light lifting (