Medical Biller

Position Summary The Medical Biller is responsible for accurately preparing, reviewing, submitting, and tracking medical claims and bills for Brain Spine & Pain Institute. The role ensures that all billable services are properly documented, coded, submitted, and monitored through payment or resolution. The Medical Biller works closely with Providers, Scribes, Records, Scheduling, and other administrative teams to resolve documentation issues, minimize billing delays, and ensure accurate and timely revenue collection while maintaining compliance with HIPAA and internal procedures. Key Responsibilities 1. Encounter & Documentation Review Review completed and approved encounter notes for billing readiness. Verify that all billable services and procedures are appropriately documented. Identify missing, incomplete, or unapproved notes and follow up with the appropriate team. Confirm that procedure notes and supporting documentation are available before billing. Verify patient, date of service, provider, diagnosis, and procedure information. 2. Medical Coding & Charge Entry Assign or verify appropriate ICD-10, CPT, and HCPCS codes based on approved documentation. Enter charges accurately into DrChrono and other applicable billing systems. Ensure all billable services are captured without duplication or omission. Identify coding or documentation discrepancies and escalate them for review when necessary. Follow established coding and billing guidelines and internal procedures. 3. Claim & Bill Preparation Prepare claims, CMS-1500/HCFA forms, and other required billing documents. Verify billing information before submission. Ensure claims contain all required patient, provider, diagnosis, procedure, and payer information. Submit bills and claims through the appropriate designated billing channels. Ensure all billing is supported by the required documentation. 4. Billing Submission & Tracking Submit completed bills within established billing-cycle deadlines. Maintain accurate records of submitted claims and bills. Track submission dates, amounts billed, payment status, and outstanding balances. Monitor claims and bills that have not been processed or paid. Follow up on outstanding submissions and escalate unresolved issues. 5. Payment & Reconciliation Review payment reports and other payment documentation. Reconcile submitted amounts against payments received. Identify discrepancies, duplicate payments, partial payments, missing payments, credits, or adjustments. Maintain an accurate outstanding-balance tracker. Document payment activity and outstanding balances. Escalate discrepancies requiring management or payer review. 6. Denials, Rejections & Corrections Review rejected or denied claims and determine the reason for non-payment. Correct billing errors and resubmit claims when appropriate. Follow up on claims requiring additional documentation or clarification. Maintain documentation of outstanding issues and actions taken. Escalate recurring or unresolved billing issues. 7. Coordination & Follow-up Communicate with Providers, Scribes, Records, Scheduling, and other departments regarding billing requirements. Request missing documentation necessary to complete billing. Follow up with internal teams regarding delayed approvals or incomplete records. Coordinate with authorized external parties when necessary. Escalate delays that may affect billing-cycle deadlines or revenue collection. 8. Billing Reports & Records Maintain accurate billing trackers and internal reports. Prepare billing-cycle summaries showing submitted, paid, and outstanding amounts. Maintain supporting documentation for submitted bills and payments. Assist with identifying billing trends, recurring issues, and workflow bottlenecks. Ensure billing records are organized and readily available for audit or review. 9. Compliance & Quality Control Maintain strict patient confidentiality and comply with HIPAA requirements. Follow established billing, coding, and documentation procedures. Conduct quality checks before submitting claims. Protect against duplicate billing and inaccurate submissions. Ensure all billing activity is supported by appropriate documentation. Key Competencies: Strong knowledge of medical billing and claims processes. Working knowledge of ICD-10, CPT, and HCPCS coding. Excellent attention to detail and numerical accuracy. Strong organizational and time-management skills. Ability to manage high-volume billing workloads and strict deadlines. Strong analytical and reconciliation skills. Effective written and verbal communication. Proficiency in DrChrono is an added requirement. Strong proficiency in Microsoft Office, particularly Excel, Word, and Outlook, is required. Ability to work independently while coordinating effectively with multiple departments. Strong problem-solving and follow-up skills. Understanding of HIPAA and patient confidentiality requirements. Key Performance Indicators (KPIs): 100% of billing-ready encounters reviewed and processed within the established billing-cycle timeframe. Bills submitted accurately and within required deadlines. Minimal coding, data-entry, and submission errors. 100% of submitted bills appropriately tracked through payment or resolution. Timely identification and follow-up of rejected, denied, unpaid, or partially paid claims. Accurate reconciliation of submitted versus paid amounts. Minimal duplicate or incorrect billing submissions. All outstanding billing issues have a documented status and next action. Timely escalation of documentation, approval, payment, or system-related delays. Accurate and timely completion of billing-cycle reports and reconciliation. Compliance with HIPAA, internal billing procedures, and established turnaround times.