Medical Biller

Position Information

Position Title: Medical Biller

Reports To: Billing Supervisor

FLSA Status: Non-Exempt

Expected Weekly Hours: 32-40

Position Summary

The Medical Biller is responsible for managing all aspects of the revenue cycle, including patient payments, medical coding, claims submission, payment posting, denial management, and collections. This role ensures accurate documentation, timely reimbursement, and effective follow-through on outstanding balances. The Medical serves as a key liaison between patients, providers, and insurance carriers to maintain financial integrity and operational efficiency within the clinic.

Position Qualifications

• At least 18 years old.

• Strong knowledge of CPT, ICD-10, and HCPCS coding systems.

• Must have High School diploma or equivalent.

• Reliable transportation.

Compensation

Compensation for this role is based on experience in billing, coding, and revenue cycle management, typically ranging from $22/hour to $26/hour as a new hire.

Essential Functions

Front-End Revenue Cycle (Patient Financial Intake & Payments)

• Verify patient insurance eligibility, benefits, and coverage details.

• Collect copays, deductibles, and outstanding balances at time of service.

• Set up and maintain patient payment plans in accordance with clinic policies.

• Provide clear explanations to patients regarding financial responsibility and billing processes.

• Accurately document and post point-of-service payments.

• Work with the reception team to coordinate insurance and payment information to patients and their families.

Coding and Charge Entry

• Review provider documentation to ensure accurate CPT, ICD-10, and HCPCS codes.

• Ensure all services are coded and charges are entered accurately and timely.

• Work with providers to clarify incomplete or insufficient documentation.

• Maintain compliance with payer-specific coding and documentation requirements.

Claims Submission and Processing

• Prepare and submit clean claims to insurance carriers (electronic and paper).

• Scrub claims for errors prior to submission to reduce denials.

• Monitor claim status and ensure timely processing.

• Identify and resolve claim rejections promptly.

Payment Posting and Reconciliation

• Post insurance payments, adjustments, and patient payments accurately.

• Review Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs).

• Reconcile daily payment batches and ensure balancing with system reports.

• Identify and correct posting discrepancies.

Accounts Receivable and Denial Management

• Work aging reports and AR queues to follow up on unpaid claims.

• Investigate and resolve claim denials, underpayments, and delays.

• Submit corrected claims and appeals as needed.

• Maintain documentation of follow-up activities and outcomes.

Patient Billing and Collections

• Generate and distribute patient statements in accordance with clinic policy.

• Respond to patient billing inquiries and resolve account concerns.

• Monitor delinquent accounts and initiate appropriate collection actions.

• Set up payment arrangements and follow up on missed payments.

• Prepare and transfer eligible accounts to third-party collections agencies.

• Maintain compliance with applicable collection laws and patient communication standards.

Compliance

• Maintain strict confidentiality of patient information in accordance with HIPAA regulations.

• Ensure all billing, coding, and collection activities comply with federal and state regulations.

• Adhere to payer guidelines and contractual obligations.

• Participate in audits, quality assurance, and compliance initiatives.

• Follow OSHA and clinic safety standards where applicable.

Team Duties

• Prepare for, attend, and participate in team meetings and huddles.

• Collaborate with providers and leadership to improve documentation and reimbursement outcomes.

• Work with clinic leadership to meet revenue and performance targets.

• Maintain flexibility in scheduling and workload demands.

• Perform other duties as assigned.

Demonstrated Attributes

• Strong attention to detail and accuracy.

• Ability to manage multiple workflows across the full revenue cycle.

• Strong analytical and problem-solving skills.

• Effective communication with patients, staff, and insurance representatives.

• Ability to maintain professionalism in financial discussions with patients.

• Intermediate to advanced computer skills preferred.

• Commitment to continuous learning, adaptability, and teamwork.

Physical Demands

• Manual dexterity and eye-hand coordination.

• Prolonged sitting and computer use.

• Occasionally lift and carry items up to 50 pounds.

• If unable to meet these requirements, Mt. Spokane Pediatrics can provide accommodation.