Medical Biller

1. Review charges for accuracy and completeness prior to claim submission, identifying coding, modifier, and demographic errors that would result in rejection or denial.

2. Resolve claim edits, scrubber holds, and clearinghouse rejections on a daily basis in both athena

One and eCW.

3. Research, document, and appeal denied claims, including preparation of appeal correspondence and assembly of supporting documentation.

4. Work aged accounts receivable by payer, aging bucket, and dollar value, prioritizing by recovery likelihood and timely filing exposure.

5. Contact payers by telephone and portal to obtain claim status, resolve processing errors, and pursue reprocessing.

6. Perform root-cause analysis on recurring denials and communicate the coding, configuration, or front-end workflow corrections required to prevent recurrence.

7. Post electronic remittance advice (835) files and manual EOBs across assigned client practices and payers in both systems.

8. Reconcile each posting batch to the corresponding bank deposit and resolve variances prior to batch closure.

9. Work the unpostables queue, identifying the cause of unapplied cash and routing transactions correctly.

10. Post takebacks, offsets, and recoupments accurately, ensuring affected accounts reflect true balances.

11. Apply contractual adjustments in accordance with the loaded fee schedule and identify allowed amounts inconsistent with contracted rates.

12. Post patient payments, refunds, and credit balances in accordance with practice policy.

13. Verify that secondary claims and crossovers generate appropriately following primary payment posting.

14. Identify and escalat underpayments, reimbursement variances, and payment patterns suggesting incorrect fee schedule configuration or payer processing error.

15. Maintain accurate, contemporaneous account and batch documentation sufficient for another team member to assume the work without loss of continuity.

16. Meet or exceed established productivity, accuracy, and turnaround standards.

17. Maintain the confidentiality and security of protected health information at all times.

18. Perform other duties as assigned in support of revenue cycle operations.

• Minimum 3 years of professional medical billing experience in a practice, billing company, or MSO setting.
• Minimum 2 years of professional payment posting experience, which may run concurrent with billing experience.
• Demonstrated hands‑on production experience in athenaOne , covering both billing and posting functions.
• Demonstrated hands‑on production experience in eClinical
  
  Works (eCW) , covering both billing and posting functions.
• Ability to read and interpret an 835 remittance file and determine claim-level disposition.
• Working knowledge of CPT, HCPCS, ICD-10, and modifier application sufficient to identify charge-level errors.
• Working knowledge of CARC and RARC denial codes, contractual adjustment versus write-off, and patient responsibility allocation.
• Experience with commercial, Medicare, and Medicaid payers.
• High school diploma or equivalent required.

• Multi‑specialty or multi‑practice experience, particularly across multiple tax identification numbers.
• Arizona AHCCCS and Medicare Part B experience.
• Prior experience in an MSO, billing company, or consulting environment.
• Exposure to fee schedule loading, maintenance, or contract rate validation.
• Experience documenting billing workflows or standard operating procedures.