Certified Medical Biller

Certified Medical Biller

Department: Billing Department
Reports To: Billing Manager / Practice Administrator
Location: Columbia Medical Practice
Employment Type: Full-Time

Position Summary

The Certified Medical Biller is responsible for accurately processing medical claims, verifying insurance coverage, submitting claims to insurance companies, and following up on outstanding balances. This role ensures timely reimbursement for services rendered while maintaining compliance with healthcare regulations and payer guidelines. The Medical Biller works closely with providers, front desk staff, and the clinical team to resolve billing discrepancies and support the financial operations of the practice.

Key Responsibilities

Claims Processing

• Prepare, review, and submit accurate medical claims to insurance carriers and clearinghouses.

• Verify patient insurance information and ensure proper documentation is attached to claims.

• Ensure all claims are coded and billed according to payer requirements.

Billing & Reimbursement

• Post insurance payments and patient payments accurately.

• Identify and resolve claim denials, rejections, and underpayments.

• Submit corrected claims and appeals when necessary.

• Monitor accounts receivable and follow up on outstanding claims.

Insurance Verification

• Confirm insurance eligibility and benefits prior to claim submission.

• Communicate with insurance companies regarding claim status, denials, and payment discrepancies.

• Maintain knowledge of payer policies and reimbursement guidelines.

Patient Account Management

• Review patient accounts for accuracy and completeness.

• Work with the front desk and clinical teams to resolve billing issues.

• Assist with patient billing inquiries when needed.

Compliance & Documentation

• Ensure billing practices follow federal and state regulations, including HIPAA compliance.

• Maintain accurate billing records and documentation.

• Stay current on updates to CPT, ICD-10, and payer guidelines.

Qualifications

Education

• High School Diploma or GED required

• Medical Billing or Healthcare Administration certification preferred

Certification

• Certified Professional Biller (CPB), Certified Medical Reimbursement Specialist (CMRS), or equivalent certification required or preferred

Experience

• Minimum of 2 years of medical billing experience in a healthcare setting

• Experience with electronic medical record (EMR) systems (AthenaOne experience preferred)

• Experience working with multiple insurance payers including Medicare, Medicaid, and commercial plans

Skills & Competencies

• Strong knowledge of medical billing procedures and insurance guidelines

• Familiarity with CPT, ICD-10, and HCPCS coding systems

• Excellent attention to detail and organizational skills

• Strong analytical and problem-solving abilities

• Effective communication and teamwork skills

• Proficiency with EMR systems and billing software

Working Conditions

• Primarily office-based environment

• Prolonged periods of sitting and working on a computer

• Occasional communication with patients, insurance companies, and staff