Medical Biller
agility billing servicesMelville (NY)
About the role
About Us:
At Agility Billing Services, we are dedicated to providing exceptional care and service in the orthopedic and pain management field. We are seeking a skilled and motivated Accounts Receivable Team Lead for commercial claims to join our team. The ideal candidate will have significant experience in collections, medical billing, and a strong understanding of commercial insurance carriers and Medicare.
Position Overview:
We are seeking a Medical Biller to join our team and support billing and collections for a busy surgical practice. The ideal candidate will have experience in medical claims follow-up, with a strong understanding of commercial and Medicare insurance plans and out-of-network billing. Prior experience in orthopedic, spine, or pain management services is highly preferred.
Qualifications:
- Working knowledge of commercial and Medicare insurance, including plan guidelines
- Experience with out-of-network billing processes; understanding of the IDR process and appeals is a plus
- Ability to review EOBs, denials, and payer communications to ensure timely appeals and maximize revenue capture
- Serve as an escalation point for complex, high-dollar, or unresolved commercial and Medicare claims from the AR team
- Excellent communication skills, particularly when working with insurance representatives and internal teams
- Proficient in ICD-10, CPT, and modifier usage
- Experience billing for orthopedic, spine, or pain management services is preferred but not required
- Strong problem-solving and organizational skills
- Self-motivated with the ability to work independently and meet deadlines
Key Responsibilities:
- Monitor, review, and follow up on outstanding commercial and Medicare claims, providing advanced support and serving as an escalation resource for unresolved, unpaid, or underpaid claims to ensure timely reimbursement
- Review, appeal, and resolve complex claim denials or payment discrepancies, including escalated issues from the AR team, using payer portals and payer communications
- Maintain up-to-date knowledge of payer policies (including LCDs), billing regulations, and coding guidelines
- Collaborate with clinical and administrative teams to ensure accurate documentation and billing practices
- Maintain organized and detailed records of claim activity, account status, and insurance correspondence
Education and Experience:
- High school diploma or equivalent required
- Medical billing or coding certification is a plus
Benefits:
- Competitive compensation based on experience, skills, and growth potential
- Opportunities for professional development and advancement in a specialty billing role
- Supportive, team-oriented work environment
- Hybrid position available after a 90-day probationary period Powered by JazzHR
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