Medical Biller in Clifton, New Jersey at Progressive Spine and Orthopaedics LLC

Medical Biller
COMPANY: Progressive Billing
PAY Range: OPM Pay Grade 5 (Hourly)
FLSA Status: Non-Exempt

SUMMARY:
The Medical Biller is responsible for performing routine medical billing activities to support timely and accurate reimbursement for healthcare services. This position prepares and submits claims, follows up on outstanding balances, resolves routine billing issues, communicates with insurance carriers and patients, and maintains accurate billing records. The Medical Biller performs work within established procedures, payer guidelines, and company policies while contributing to the overall success of the revenue cycle.

ESSENTIAL DUTIES AND RESPONSIBILITIES
Claims Processing & Follow-Up:
- Prepare, review, and submit electronic and paper claims for services rendered.
- Review claims for completeness and accuracy prior to submission.
- Correct claim errors and resubmit claims as necessary.
- Monitor claim status and follow up on unpaid, delayed, or denied claims.
- Research and resolve routine claim denials and reimbursement issues.
- Submit corrected claims and supporting documentation as needed.
- Verify insurance eligibility and benefits when required.

Accounts Receivable & Billing Support
- Work assigned accounts receivable balances to facilitate timely reimbursement.
- Review account balances and identify routine billing discrepancies.
- Generate patient statements and invoices.
- Assist patients with billing inquiries, account balances, and payment questions.
- Prepare and process refund requests and overpayment documentation.
- Document account activity and maintain accurate billing records.

Administrative Support
- Prepare correspondence and supporting billing documentation.
- Generate retroactive authorization requests and payer-related forms as needed.
- Maintain organized billing records and supporting documentation.
- Assist with billing reports and departmental projects.
- Perform other duties as assigned.

QUALIFICATIONS
- High school diploma or equivalent required.
- Medical billing certification or related education preferred.
- One (1) year of medical billing experience preferred.
- Working knowledge of medical terminology, insurance billing concepts, ICD-10, CPT, and HCPCS coding systems.
- Proficiency with billing software and electronic health record (EHR) systems.
- Strong attention to detail and accuracy.
- Effective organizational and communication skills.
- Ability to manage multiple tasks and deadlines.

GENERAL EXPECTATIONS
- Maintain professionalism and confidentiality at all times.
- Adhere to HIPAA requirements and company policies.
- Demonstrate reliability, accountability, and teamwork.
- Complete assigned work accurately and within established timeframes.
- Support departmental and organizational goals.

PHYSICAL DEMANDS AND WORK ENVIRONMENT
This position primarily operates in a professional office environment and requires prolonged periods of sitting, computer use, and operation of standard office equipment. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions of the position.

DOL / FLSA CLASSIFICATION AND JUSTIFICATION
Based on the duties described above, the Medical Biller position is appropriately classified as non-exempt under the Fair Labor Standards Act (FLSA). The primary duties involve claim processing, billing follow-up, account maintenance, and routine revenue cycle functions performed within established procedures and guidelines. The position does not exercise the level of discretion and independent judgment required for exemption and does not supervise employees or formulate company policy. Accordingly, the position is properly classified as hourly, non-exempt, and eligible for overtime compensation in accordance with applicable wage and hour laws.

The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities, or physical requirements. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.