Medical Biller

Job Summary 

The Biller is responsible for the accurate and timely preparation, submission, and follow-up of medical claims to payers. This role ensures all billing activities are performed in accordance with applicable federal, state, and payer-specific guidelines. The Biller works within the organization’s Electronic Medical Record (EMR) system, handling Protected Health Information (PHI) with the highest level of confidentiality and compliance. This position plays a key role in supporting the organization’s financial health and adherence to HIPAA regulations. 

Essential Duties and Responsibilities 

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodation may be made to enable individuals with disabilities to perform these functions. Other duties may be assigned as necessary. 

• Prepare and submit accurate claims to Medicare, Medicaid, commercial insurance, and other third-party payers. 

• Review clinical and administrative documentation in the EMR to verify accuracy and completeness prior to billing. 

• Maintain a clear understanding of billing codes, modifiers, and payer requirements to minimize rejections and denials. 

• Work within the EMR system to access, document, and reconcile billing-related data. 

• Monitor claim statuses and follow up promptly on unpaid, denied, or underpaid claims. 

• Post payments and adjustments accurately within the billing system. 

• Investigate and resolve billing discrepancies, documentation issues, and payer denials. 

• Handle confidential PHI in accordance with HIPAA and company policies at all times. 

• Communicate effectively with internal departments, patients, and payer representatives to resolve billing issues. 

• Stay current on changes to billing regulations, payer guidelines, and healthcare compliance requirements. 

• Assist with internal audits and provide supporting documentation as needed. 

• Perform regular quality control checks on billing data to ensure accuracy and completeness. 

• Uphold strict confidentiality and privacy standards in all aspects of work involving PHI and patient records. 

Skills, Abilities, and Knowledge Requirements 

• Strong understanding of medical billing processes, including Medicare/Medicaid and commercial insurance. 

• Proficiency in using Electronic Medical Record (EMR) systems for billing and documentation review. 

• Working knowledge of HIPAA regulations and proper handling of PHI. 

• Familiarity with claim forms (e.g., CMS-1500), billing codes (ICD-10, CPT/HCPCS), and modifier usage. 

• Strong attention to detail with the ability to identify and resolve billing discrepancies. 

• Proficiency with Microsoft Office (Excel, Word, Outlook) and use of payer portals and clearinghouses. 

• Excellent written and verbal communication skills for internal and external interactions. 

• Ability to work independently, manage multiple tasks, and meet deadlines in a fast-paced environment. 

• Understanding of healthcare documentation and how it impacts billing and reimbursement. 

Minimum Qualifications 

• High school diploma or equivalent required; associate degree or medical billing certification preferred. 

• Minimum of 2 years of healthcare billing experience, preferably in home health or similar healthcare setting. 

• Experience working with EMR systems; Kantime experience strongly preferred. 

• Demonstrated knowledge of HIPAA compliance, PHI security practices, and healthcare regulatory standards. 

• Familiarity with billing for government and commercial payers, including authorization and denial management processes.