Bilingual Medical Biller – Accounts Receivable & Revenue Cycle Specialist

We are seeking a highly motivated, detail-oriented, and experienced Medical Biller to a growing orthopedic practice. This role is not about passive data entry; it is a dynamic position focused heavily on Accounts Receivable (AR) cleanup, proactive eligibility troubleshooting, and root-cause denial resolution.

The ideal candidate will manage the billing lifecycle for two of our four busy office locations, collaborating closely with an existing eligibility partner, front-desk staff, and providers to stabilize and optimize our revenue cycle.

Key Responsibilities:
Core AR Cleanup & Denials Management

• Aged Claims Resolution: Dive deep into the EMR system to audit, work, and successfully resolve outstanding claims and denials that have sat untouched past 30 days.
• Root-Cause Fixing: Identify back-end denial trends (specifically regarding eligibility discrepancies and missing referrals) and implement front-end workflows to prevent recurrence.
• Appeals & Follow-Ups: Aggressively pursue underpaid or denied claims with major commercial payers (Aetna, Anthem, UnitedHealthcare, Cigna) as well as state/third-party plans.

Financial Posting & Administrative Support

• Payment Posting: Accurately process and post financial data into the EMR, including Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs).
• Ancillary Tracking: Proactively communicate with physicians, surgeons, and medical assistants to hunt down missing clinical documentation (such as operative reports or prior authorizations) essential for claim payment.
• Patient Collections: Directly accept and process patient payments securely over the phone.

Meticulous Documentation & Compliance

• Rigorous Account Noting: Maintain a massive focus on highly detailed account noting. Every single touchpoint regarding the revenue cycle (e.g., insurance representative directives, patient promises to pay) must be thoroughly documented in the system so that any future reviewer has instant, unambiguous context.

Requirements

Technical & System Skills

• EMR Experience: Proficient in ModMed (Modernizing Medicine) is highly preferred (experience with similar platforms like eClinicalWorks, AthenaHealth, or Kareo will be considered).

• Specialty Knowledge: Strong, functional knowledge of Orthopedic billing workflows, including common orthopedic CPT/ICD-10 coding combinations, modifiers, and specialized global surgical billing windows.
• Insurance Portals: Expert familiarity with navigating major clearinghouses and payer portals (e.g., Availity, Optum, insurance-specific portals).

Operational & Behavioral Competencies

• The “One Week Ahead” Mindset: A proactive organizational style. You naturally aim to audit schedules and verify complex benefits 5 to 7 days in advance to successfully absorb high-volume, same-day add-on appointments.
• Radical Accountability & Direct Communication: An honest, transparent communicator who works collaboratively as a team player, addresses mistakes head-on to find immediate fixes, and seamlessly partners with upper management, clinic staff, and attorneys.
• Bilingual Capability: Fluency in English and Spanish is highly valued to assist our diverse patient demographic with billing concerns empathetically.

Originally posted on Himalayas