The Senior Revenue Cycle Biller will be responsible for managing the billing functions of a multispecialty physician office, ensuring timely and accurate billing of claims. In addition to performing any required payment posting and reconciliation. This role involves working closely with physicians, clinical staff, patient access, finance and the revenue cycle team to resolve billing and payment posting issues, maintain accurate patient and insurance data, and ensure compliance with all regulatory requirements

Essential Functions:

Billing and Claims Processing:

o Submit clean claims to payers in a timely manner for services provided by the physicians across various specialties.
o Review and ensure proper coding of patient encounters based on physician documentation, ICD-10, CPT, and HCPCS codes.
o Monitor and manage outstanding claims, resolving denials, underpayments, and discrepancies in a timely manner.
o Reconcile patient accounts and ensure that all services provided are properly billed.

Insurance Verification and Coordination:
o Verify patient insurance coverage and eligibility, ensuring accurate and up-to-date information is available before claim submission.
o Communicate with insurance providers to clarify discrepancies, request payment, or resolve any issues related to claim status.

Denial Management and Resolution:
o Identify and work to resolve claim denials, underpayments, and rejections.
o Collaborate with the clinical and coding teams to understand the root causes of denials and implement corrective actions.
o Work with patients to resolve unpaid balances and provide them with clear explanations of charges, payment plans, or financial assistance programs.

Patient Billing and Communication:

Ensure patient billing statements are accurate, clear, and sent in a timely manner.
o Address patient inquiries regarding their accounts, charges, and insurance claims in a professional and compassionate manner.

Payment Posting and Reconciliation:
o Accurately apply electronic and manual payments, adjustments, and denials to patient accounts
o Balance daily deposits with system totals and bank statements (as applicable)

Compliance and Documentation:
o Ensure that billing practices adhere to all applicable local, state, and federal regulations, including HIPAA, Medicare, Medicaid, and commercial insurance requirements.
o Stay current with changes in healthcare billing regulations, payer-specific requirements, and coding updates.

Reporting and Analysis:
o Generate and analyze revenue cycle reports to identify trends, areas of concern, and opportunities for improvement.
o Provide regular updates on billing performance, accounts receivable, and revenue cycle metrics to management.
o Assist in preparing monthly, quarterly, and annual financial reports for the practice.

Training and Mentoring:
o Provide guidance and mentorship to junior billers, ensuring that best practices are followed.
o Assist in the development of training materials and processes for new billing team members.
o Conduct periodic in-service training sessions to keep staff updated on industry changes and internal procedures.

Knowledge, Skills and Abilities:

o Knowledge of Medicare, Medicaid and Commercial payers.

o Strong attention to detail and accuracy in all aspects of billing and coding. 
o Ability to work independently and manage multiple priorities in a fast-paced environment. 
o Excellent communication and interpersonal skills, especially when dealing with patients, insurance providers, and internal staff.
o Ability to analyze and resolve complex billing issues and discrepancies. 
o Strong knowledge of HIPAA regulations and patient confidentiality protocols.

Minimum Education: High School Diploma or GED

Minimum Expereince: 

• At least 5 years of experience in medical billing, with significant exposure to multispecialty physician billing. 
• Experience with healthcare billing software (e.g., Epic, Cerner, or similar platforms).