Billing Representative

Job Title: Billing Representative (Remote)

Job Overview:

You are responsible for supporting the complete revenue cycle. Your primary focus is ensuring claims are submittedaccurately and timely claim holds are actively worked outstanding accounts receivable is followed through toresolution and payment or denial issues are identified and addressed promptly.

You are expected to actively manage assigned billing workrather than simply identify or report issues. Success in this role requires strong attention to detail consistentfollow-through knowledge of medical billing and payer requirements and the ability to independently research andresolve claim issues.

You will work closely with the Practice Administrator providers clinical staff front desk staffand external revenue cycle or payer representatives as needed. This position has no supervisory responsibilities ordirect or indirect reports.

Responsibilities:

Claim Submission & Management

• Review claims for completeness coding-related edits demographic issues insurance information required modifiers and other potential submission errors
• Monitor claims-in-hold and claim-edit work queues daily and resolve issues preventing claim submission
• Research rejected claims and make necessary corrections for resubmission
• Identify recurring claim submission problems and escalate trends to the Practice Administrator
• Ensure corrected claims replacement claims and other resubmissions are completed accurately and appropriately documented
• Monitor claims through the billing cycle to ensure they are successfully accepted and adjudicated

Accounts Receivable

• Follow up on unpaid underpaid denied rejected or otherwise unresolved claims
• Prioritize aging accounts and high-dollar balances to prevent unnecessary revenue loss
• Contact insurance carriers or use payer portals to determine claim status and identify barriers to payment
• Research accounts that have exceeded expected payer processing timelines
• Take appropriate corrective action to move outstanding claims toward resolution
• Escalate significant or recurring A/R issues to the Practice Administrator
• Assist with maintaining A/R within practice-established performance expectations

Denials & Appeals

• Review denied claims to determine the reason for denial and appropriate corrective action
• Prepare and submit reconsiderations appeals supporting documentation and medical records when required
• Monitor submitted appeals and reconsiderations through final resolution
• Identify patterns in denials and communicate trends that may require changes to billing codingdocumentation registration or clinical workflows
• Work collaboratively with providers and staff when additional documentation or clarification is required
  

Payment & Account Review

• Review accounts for payment discrepancies incorrect adjustments underpayments and payer processingerrors
• Verify that insurance payments and adjustments are consistent with expected reimbursement whenappropriate
• Research credit balances unapplied payments and other account discrepancies as assigned
• Coordinate with the appropriate internal or external parties when payment posting corrections are required
  

Dermatology & Billing Support

• Support billing for general dermatology surgical repairs biopsies excisions destructionprocedures pathology photodynamic therapy and other services performed by the practice
• Maintain working knowledge of common dermatology and Mohs CPT and ICD-10 coding requirements
• Recognize common modifier requirements and billing scenarios associated with dermatology and services
• Identify potential bundling medical necessity LCD/NCD authorization or payer-specific issues affecting
  reimbursement
• Review billing-related documentation when necessary to support accurate claim submission or appeal activity
• Stay current on payer policies and billing requirements that affect the practice
  

Insurance & Eligibility Issues

• Research insurance eligibility coordination of benefits authorization referral and coverage issues affecting
  claims
• Work with front desk or clinical staff to obtain missing or corrected insurance information when necessary
• Identify registration or insurance-entry errors contributing to claim rejections or denials
• Assist with resolving payer-specific requirements that delay or prevent reimbursement
  

Billing Work Queues & Reporting

• Monitor assigned billing work queues consistently and prevent unresolved items from accumulating
• Maintain accurate notes documenting billing actions payer communication follow-up dates and accountstatus
• Assist with A/R aging reports denial reports claim-hold reports and other revenue cycle reporting asrequested
• Track outstanding billing issues and ensure appropriate follow-up occurs until resolution
• Provide the Practice Administrator with updates on significant billing issues trends or revenue concerns
• Participate in billing audits and account reviews as requested

Compliance & Documentation

• Perform billing activities in accordance with Medicare Medicaid commercial payer and applicable federal andstate requirements
• Maintain accurate and complete documentation of billing activity
• Protect patient financial and health information in accordance with HIPAA and practice policies
• Immediately escalate suspected billing coding compliance or reimbursement concerns to the PracticeAdministrator
• Maintain confidentiality of patient provider and practice financial information

Qualification:

Required

• Prior medical billing revenue cycle or insurance claims experience
• Working knowledge of medical claims submission and insurance follow-up
• Experience researching denied rejected unpaid and underpaid claims
• Understanding of CPT ICD-10 modifiers and basic medical billing principles
• Ability to independently research and resolve billing issues
• Strong attention to detail and accuracy
• Strong organizational and follow-up skills
• Ability to manage multiple billing priorities and work queues simultaneously
• Strong written and verbal communication skills
• Ability to maintain patient and financial confidentiality

Preferred

• Previous dermatology and/or Mohs surgery billing experience
• Experience with Medicare and commercial insurance billing
• Experience with surgical and procedural billing
• Familiarity with LCDs medical necessity requirements claim edits bundling rules corrected claims andappeals
• Experience using electronic health record and practice management systems
• Experience working A/R and denial-management work queues

Schedule: Night Shift

Setup: Remote

Why Join STAFFVIRTUAL

• Competitive compensation and benefits package
  • HMO Day 1 FREE dependent coverage
  • Allowances
  • Attendance bonus
  • Paid time offs
• Company-provided work setup (laptop monitor accessories)
• Training career growth and global exposure
• A collaborative and supportive team culture

If youre a motivated client-focused professional whos ready to grow with a company that values people and performance wed love to hear from you. Apply now and join our dynamic team at STAFFVIRTUAL!