About Us:At Agility Billing Services, we are dedicated to providing exceptional care and service in the orthopedic and pain management field. We are seeking a skilled and motivated Accounts Receivable Team Lead for commercial claims to join our team. The ideal candidate will have significant experience in collections, medical billing, and a strong understanding of commercial insurance carriers and Medicare.
Position Overview:We are seeking a Medical Biller to join our team and support billing and collections for a busy surgical practice. The ideal candidate will have experience in medical claims follow-up, with a strong understanding of commercial and Medicare insurance plans and out-of-network billing. Prior experience in orthopedic, spine, or pain management services is highly preferred.
Qualifications:โข Working knowledge of commercial and Medicare insurance, including plan guidelines
โข Experience with out-of-network billing processes; understanding of the IDR process andย ย ย appeals is a plus
โข Ability to review EOBs, denials, and payer communications to ensure timely appeals andย ย ย maximize revenueย captureย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย โข Serve as an escalation point for complex, high-dollar, or unresolved commercial andย ย ย ย ย ย Medicare claims from the AR team
โข Excellent communication skills, particularly when working with insurance representativesย ย ย and internal teams
โข Proficient in ICD-10, CPT, and modifier usage
โข Experience billing for orthopedic, spine, or pain management services is preferred but notย ย required
โข Strong problem-solving and organizational skills
โข Self-motivated with the ability to work independently and meet deadlines
Key Responsibilities:โข Monitor, review, and follow up on outstanding commercial and Medicare claims, providingย ย advanced support and serving as an escalation resource for unresolved, unpaid, orย ย ย ย ย ย ย underpaid claims to ensure timely reimbursement
โข Review, appeal, and resolve complex claim denials or payment discrepancies, includingย ย ย escalated issues from the AR team, using payer portals and payer communications
โข Maintain up-to-date knowledge of payer policies (including LCDs), billing regulations, andย ย coding guidelines
โข Collaborate with clinical and administrative teams to ensure accurate documentation andย ย billing practices
โข Maintain organized and detailed records of claim activity, account status, and insuranceย ย ย correspondence
Education and Experience:โข High school diploma or equivalent required
โข Medical billing or coding certification is a plus
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Benefits:โข Competitive compensation based on experience, skills, and growth potential
โข Opportunities for professional development and advancement in a specialty billing role
โข Supportive, team-oriented work environment
โข Hybrid position available after a 90-day probationary period
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