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Medical Billing Associate

Status: Non-Exempt / Full Time / On Site

Medical Specialty: Women's Health - OB/GYN

Job Summary

The Medical Biller is responsible for preparing, submitting, and monitoring medical claims to ensure timely and accurate reimbursement from insurance companies, government payers, and patients. This position plays a critical role in the revenue cycle by reviewing documentation for billing accuracy, resolving claim denials, posting payments, and maintaining compliance with payer guidelines and healthcare regulations. The Medical Biller collaborates with providers, coding staff, insurance companies, and patients to maximize reimbursement while delivering excellent customer service.

Essential Duties and Responsibilities

• Review patient accounts, clinical documentation, and charge information for completeness and billing accuracy.
• Prepare and submit electronic and paper claims to commercial insurance carriers, Medicare, Medicaid, Workers' Compensation, and other third-party payers.
• Verify insurance eligibility, benefits, coverage, and patient demographic information prior to claim submission.
• Review medical records to ensure appropriate documentation supports billed services.
• Work collaboratively with third party billing partner and providers to ensure accurate assignment of CPT, HCPCS, and ICD-10-CM codes.
• Monitor claim status and follow up on unpaid, delayed, or rejected claims.
• Investigate and resolve claim rejections, denials, and payment discrepancies by correcting claims and submitting timely appeals when appropriate.
• Prepare and submit corrected claims, reconsiderations, and payer appeals with supporting documentation.
• Post insurance and patient payments accurately into the practice management system.
• Reconcile daily payment batches, deposits, and explanation of benefits (EOBs) or electronic remittance advice (ERA).
• Calculate and apply patient deductibles, copayments, coinsurance, and contractual adjustments.
• Generate and distribute patient statements and assist patients with billing questions and payment arrangements.
• Maintain accurate billing documentation and account notes within the Electronic Health Record (EHR) and practice management system.
• Communicate with insurance companies to resolve claim issues and obtain claim status updates.
• Maintain current knowledge of payer policies, reimbursement guidelines, and regulatory requirements.
• Generate billing, accounts receivable, aging, denial, and reimbursement reports for leadership.
• Participate in revenue cycle improvement initiatives to reduce denials and improve reimbursement.
• Maintain compliance with HIPAA, CMS regulations, payer requirements, and organizational policies.
• Protect the confidentiality and security of patient financial and health information.
• Perform other duties as assigned.

Education and Experience

Required

• High school diploma or GED.
• Minimum of one (1) year of medical billing, insurance claims processing, or revenue cycle experience in a healthcare setting.

Preferred

• Associate degree in Medical Billing and Coding, Health Information Management, Healthcare Administration, or a related field.
• Certified Professional Biller (CPB), Certified Professional Coder (CPC), Certified Coding Associate (CCA), or other industry-recognized certification preferred.
• Experience billing multiple specialties and working with commercial insurance, Medicare, Medicaid, and managed care organizations.

Knowledge, Skills, and Abilities

• Strong knowledge of medical billing processes and revenue cycle management.
• Working knowledge of CPT, ICD-10-CM diagnosis coding, and medical terminology.
• Understanding of insurance verification, claim submission, payment posting, denial management, and appeals.
• Knowledge of payer policies, Medicare, Medicaid, commercial insurance, and managed care reimbursement guidelines.
• Proficiency with Electronic Health Record (EHR) and practice management systems, ie AdvancedMD, eClinicalWorks, Athenahealth, Oracle Health (Cerner), Epic, or similar platforms.
• Experience with electronic claims submission, clearinghouses, ERA, and EOB processing.
• Strong analytical and problem-solving skills with attention to detail.
• Excellent mathematical skills for balancing accounts, reconciling payments, and calculating patient financial responsibility.
• Strong organizational and time management skills with the ability to prioritize multiple deadlines.
• Excellent written and verbal communication skills.
• Strong customer service skills when assisting patients with billing inquiries.
• Ability to work independently and collaboratively within a healthcare revenue cycle team.
• Ability to maintain confidentiality and comply with HIPAA and other healthcare privacy regulations.

Physical Requirements

• Ability to sit for extended periods while using a computer.
• Ability to operate a computer, keyboard, calculator, telephone, and other standard office equipment.
• Ability to occasionally lift, carry, push, or pull up to 25 pounds.
• Ability to communicate effectively in person, electronically, and by telephone.

Work Environment

• Work is performed in a medical office or centralized billing office.
• Frequent interaction with providers, coding staff, insurance representatives, patients, and revenue cycle personnel.
• Fast-paced environment requiring accuracy, attention to detail, and adherence to billing deadlines and regulatory requirements.

Core Competencies

• Revenue Cycle Management
• Medical Billing and Claims Processing
• Insurance and Payer Knowledge
• Attention to Detail
• Analytical Thinking
• Problem Solving
• Organization and Time Management
• Customer Service
• Communication
• Regulatory Compliance
• Confidentiality and Ethics
• Accountability
• Teamwork
• Continuous Process Improvement

Other:

Pay: Commensurate with Experience
Expected hours: 40 per week

Benefits: (Waiting period may apply)

• Dental insurance
• Disability insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance
• 401(k) / Profit Sharing