You are responsible for supporting the complete revenue cycle. Your primary focus is ensuring claims are submitted accurately and timely, claim holds are actively worked, outstanding accounts receivable is followed through to resolution, and payment or denial issues are identified and addressed promptly.You are expected to actively manage assigned billing work rather than simply identify or report issues. Success in this role requires strong attention to detail, consistent follow-through, knowledge of medical billing and payer requirements, and the ability to independently research and resolve claim issues.You will work closely with the Practice Administrator, providers, clinical staff, front desk staff, and external revenue cycle or payer representatives as needed. This position has no supervisory responsibilities or direct or indirect reports.Responsibilities:Claim Submission & ManagementReview claims for completeness, coding-related edits, demographic issues, insurance information, required modifiers, and other potential submission errorsMonitor claims-in-hold and claim-edit work queues daily and resolve issues preventing claim submissionResearch rejected claims and make necessary corrections for resubmissionIdentify recurring claim submission problems and escalate trends to the Practice AdministratorEnsure corrected claims, replacement claims, and other resubmissions are completed accurately and appropriately documentedMonitor claims through the billing cycle to ensure they are successfully accepted and adjudicatedAccounts ReceivableFollow up on unpaid, underpaid, denied, rejected, or otherwise unresolved claimsPrioritize aging accounts and high-dollar balances to prevent unnecessary revenue lossContact insurance carriers or use payer portals to determine claim status and identify barriers to paymentResearch accounts that have exceeded expected payer processing timelinesTake appropriate corrective action to move outstanding claims toward resolutionEscalate significant or recurring A/R issues to the Practice AdministratorAssist with maintaining A/R within practice-established performance expectationsDenials & AppealsReview denied claims to determine the reason for denial and appropriate corrective actionPrepare and submit reconsiderations, appeals, supporting documentation, and medical records when requiredMonitor submitted appeals and reconsiderations through final resolutionIdentify patterns in denials and communicate trends that may require changes to billing, coding, documentation, registration, or clinical workflowsWork collaboratively with providers and staff when additional documentation or clarification is requiredPayment & Account ReviewReview accounts for payment discrepancies, incorrect adjustments, underpayments, and payer processing errorsVerify that insurance payments and adjustments are consistent with expected reimbursement when appropriateResearch credit balances, unapplied payments, and other account discrepancies as assignedCoordinate with the appropriate internal or external parties when payment posting corrections are requiredDermatology & Billing SupportSupport billing for general dermatology, surgical repairs, biopsies, excisions, destruction procedures, pathology, photodynamic therapy, and other services performed by the practiceMaintain working knowledge of common dermatology and Mohs CPT and ICD-10 coding requirementsRecognize common modifier requirements and billing scenarios associated with dermatology and servicesIdentify potential bundling, medical necessity, LCD/NCD, authorization, or payer-specific issues affecting reimbursementReview billing-related documentation when necessary to support accurate claim submission or appeal activityStay current on payer policies and billing requirements that affect the practiceInsurance & Eligibility IssuesResearch insurance eligibility, coordination of benefits, authorization, referral, and coverage issues affecting claimsWork with front desk or clinical staff to obtain missing or corrected insurance information when necessaryIdentify registration or insurance-entry errors contributing to claim rejections or denialsAssist with resolving payer-specific requirements that delay or prevent reimbursementBilling Work Queues & ReportingMonitor assigned billing work queues consistently and prevent unresolved items from accumulatingMaintain accurate notes documenting billing actions, payer communication, follow-up dates, and account statusAssist with A/R aging reports, denial reports, claim-hold reports, and other revenue cycle reporting as requestedTrack outstanding billing issues and ensure appropriate follow-up occurs until resolutionProvide the Practice Administrator with updates on significant billing issues, trends, or revenue concernsParticipate in billing audits and account reviews as requestedCompliance & DocumentationPerform billing activities in accordance with Medicare, Medicaid, commercial payer, and applicable federal and state requirementsMaintain accurate and complete documentation of billing activityProtect patient financial and health information in accordance with HIPAA and practice policiesImmediately escalate suspected billing, coding, compliance, or reimbursement concerns to the Practice AdministratorMaintain confidentiality of patient, provider, and practice financial informationQualification:RequiredPrior medical billing, revenue cycle, or insurance claims experienceWorking knowledge of medical claims submission and insurance follow-upExperience researching denied, rejected, unpaid, and underpaid claimsUnderstanding of CPT, ICD-10, modifiers, and basic medical billing principlesAbility to independently research and resolve billing issuesStrong attention to detail and accuracyStrong organizational and follow-up skillsAbility to manage multiple billing priorities and work queues simultaneouslyStrong written and verbal communication skillsAbility to maintain patient and financial confidentialityPreferredPrevious dermatology and/or Mohs surgery billing experienceExperience with Medicare and commercial insurance billingExperience with surgical and procedural billingFamiliarity with LCDs, medical necessity requirements, claim edits, bundling rules, corrected claims, and appealsExperience using electronic health record and practice management systemsExperience working A/R and denial-management work queuesSchedule: Night ShiftSetup: RemoteWhy Join STAFFVIRTUAL?Competitive compensation and benefits packageHMO Day 1 + FREE dependent coverageAllowancesAttendance bonusPaid time offsCompany-provided work setup (laptop, monitor, accessories)Training, career growth, and global exposureA collaborative and supportive team cultureIf you're a motivated, client-focused professional who's ready to grow with a company that values people and performance, we'd love to hear from you. Apply now and join our dynamic team at STAFFVIRTUAL!
17 days ago