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:• Working knowledge of commercial and Medicare insurance, including plan guidelines
• Experience with out-of-network billing processes; understanding of the IDR process and appeals is a plus
• Ability to review EOBs, denials, and payer communications to ensure timely appeals and maximize revenue capture • Serve as an escalation point for complex, high-dollar, or unresolved commercial and Medicare claims from the AR team
• Excellent communication skills, particularly when working with insurance representatives and internal teams
• Proficient in ICD-10, CPT, and modifier usage
• Experience billing for orthopedic, spine, or pain management services is preferred but not required
• Strong problem-solving and organizational skills
• Self-motivated with the ability to work independently and meet deadlines
Key Responsibilities:• Monitor, review, and follow up on outstanding commercial and Medicare claims, providing advanced support and serving as an escalation resource for unresolved, unpaid, or underpaid claims to ensure timely reimbursement
• Review, appeal, and resolve complex claim denials or payment discrepancies, including escalated issues from the AR team, using payer portals and payer communications
• Maintain up-to-date knowledge of payer policies (including LCDs), billing regulations, and coding guidelines
• Collaborate with clinical and administrative teams to ensure accurate documentation and billing practices
• Maintain organized and detailed records of claim activity, account status, and insurance correspondence
Education and Experience:• High school diploma or equivalent required
• Medical billing or coding certification is a plus
Benefits:• Competitive compensation based on experience, skills, and growth potential
• Opportunities for professional development and advancement in a specialty billing role
• Supportive, team-oriented work environment
• Hybrid position available after a 90-day probationary period
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