Description
Manage end-to-end medical billing and revenue cycle functions using knowledge of medical terminology, coding, and payer rules. Prepare and submit claims, post payments, resolve denials, and maintain accurate patient accounts while communicating with insurers, patients, and clinical staff.
- • Verify patient insurance eligibility, benefits, and coverage limits.
- • Obtain and track prior authorizations and referrals per payer requirements.
- • Review encounters and charges for coding completeness and accuracy (ICD-10, CPT/HCPCS).
- • Coordinate with coders and clinicians to correct documentation or coding issues.
- • Enter and batch charges into the practice management or RCM system.
- • Prepare, scrub, and submit electronic and paper claims via clearinghouses/EDI.
- • Monitor claim acceptance and rejections; correct edits and resubmit promptly.
- • Post ERA/EOB payments, adjustments, and denials to patient accounts.
- • Reconcile daily charges, payments, and deposits; balance billing reports.
- • Work accounts receivable aging and follow up on unpaid or underpaid claims.
- • Analyze and appeal denials; draft appeal letters with supporting documentation.
- • Generate patient statements, process refunds, and set up payment plans.
- • Perform collections activities in line with policy and regulations.
- • Respond to patient and payer billing inquiries and explain benefits and balances.
- • Maintain billing records, fee schedules, and payer information.
- • Produce routine revenue cycle reports and KPIs for management.
- • Ensure compliance with HIPAA, OIG guidance, and payer policies; safeguard PHI.
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Healthcare & Human Services
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Tasks & skills:
O*NET occupational data (work activities, skills, knowledge).
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Last reviewed: Jan 2026
