The Medical Biller is responsible for managing end-to-end Revenue Cycle Management (RCM) for multi-specialty practices, including but not limited to Family Medicine, Internal Medicine (IM), PCP, and other specialties.
Primary focus will be on End to End Revenue Cycle Management (BNE, AUTH, PATIENT INBOUND CALLS, PAYMENT POSTING, DENIAL MANAGEMENT, AR, COLLECTION, APPEALS) to ensure timely reimbursement and overall financial health of the practice.
This role works closely with providers, payers, patients, and internal teams to maintain compliance, improve collections, and support sustainable revenue growth.
Revenue Cycle Management – End-to-End
- Manage the full billing lifecycle, including benefit verification, eligibility checks, prior authorizations/utilization review, charge entry, clean claim submission, payment posting, AR follow-ups, denial management, appeals, and patient collections.
- Ensure timely and accurate claim submission to all payers, adhering to payer-specific guidelines and filing limits.
- Review clinical documentation across multiple specialties to ensure coding accuracy, medical necessity, and proper modifier usage.
- Apply and correct CPT, ICD-10 codes, and modifiers, ensuring compliance and optimal reimbursement.
- Utilize multiple EHR/EMR and Practice Management (PM) systems, including Practice Fusion, eClinicalWorks (eCW),Athena, Simple Practice, and any other major EHR/EMR, as required.
- Demonstrate the ability to quickly adapt to and work efficiently across multiple systems simultaneously.
- Proactively follow up on unpaid, underpaid, or denied claims.
- Analyze denials, perform root-cause analysis, and submit timely appeals with appropriate documentation.
- Prepare, reconcile, and distribute accurate patient statements.
- Monitor AR aging reports and work assigned buckets to resolution.
Maintain consistent follow-up to reduce AR days and improve cash flow.
Claims Management & Accounts Receivable (AR)
- Track and capture all visits and services to ensure complete and accurate billing.
- Verify patient demographics, insurance eligibility, benefits, and authorization requirements prior to claim submission.
- Demonstrate a thorough understanding of AR reporting and the ability to prioritize work based on aging, payer behavior, and reimbursement risk.
- Identify trends in AR and denials and recommend corrective actions.
Financial Coordination & Reconciliation
- Reconcile patient and payer accounts; maintain organized billing and financial records.
- Accurately post payments, adjustments, and refunds.
- Manage patient balances, payment plans, and outstanding receivables.
- Generate monthly and ad hoc billing and financial reports for leadership review.
Provider, Patient & Insurance Coordination
- Communicate effectively with providers regarding documentation gaps, coding clarifications, and specialty-specific requirements.
- Coordinate with insurance payers, clearinghouses, and portals, including Availity, for claim status, eligibility, and issue resolution.
- Communicate professionally with patients and clients, including handling inbound calls related to billing inquiries, statements, and balances.
EDI, ERA & Payment Processing
- Demonstrate working knowledge of most common EDI and ERA systems/workflows, including claim submission and remittance processing.
- Manage and maintain EFT enrollments with payers.
- Ensure accurate reconciliation between ERA/EOBs and posted payments.
Compliance & Reporting
- Maintain HIPAA compliance and adherence to payer, state, and federal regulations.
- Generate and analyze RCM performance reports, including AR aging, denial trends, and reimbursement metrics.
Identify workflow gaps and recommend process improvements and best practices.
Key Qualifications:
- 5–8+ years of hands-on experience in Revenue Cycle Management.
- Experience with multi-specialty billing, including but not limited to Family Medicine, Internal Medicine (IM), PCP, and other specialties.
- Proven experience working with multiple EHR, EMR, and PM systems.
- Strong proficiency in Availity and other payer/EDI portals
- Solid understanding of:
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- CPT and ICD-10 coding
- Modifier usage and corrections
- Medical necessity documentation
- Denial management, appeals, and follow-ups
- AR management and reporting
- Benefits verification and prior authorizations
- EDI/ERA processing and EFT enrollments
- Experience with US payers (Commercial, Medicare, Medicaid).
- Strong written and verbal English communication skills, particularly for appeals, payer correspondence, and patient communication.
- High level of accuracy, attention to detail, and ability to work independently.
- College degree or equivalent experience; Healthcare Administration or related field preferred.
Shift / Hours:
Monday – Friday in one single shift, anytime during the hours of 9:00 AM EST – 6:00 PM EST. Note this is +12 or +13 Philippine time, which will be 9:00 PM PHT – 6:00 AM in PHT outside of Daylight Savings Time and 10:00 PM PHT – 7:00 AM PHT.
Business Overview:
The company provides a variety of services for new and existing medical practices and has a current physician roster of ~2,500. The company works with medical practices in a variety of specialties including counseling, behavioral health, podiatry, pediatrics, urgent care, neurology, family practices, orthopedics, PT, OT, ST and others.
They have clients in all 50 states with a focus in CA, NY, TX, FL, IL, CO, Or and WA. They focus on 3 main areas: Medical, Behavioral and Dental.
Location: Jacksonville, FL