The Certified Professional Biller (CPB) is responsible for managing the full medical billing process to ensure accurate claim submission, timely reimbursement, and compliance with payer and regulatory requirements. This role requires strong knowledge of medical billing practices, insurance guidelines, and revenue cycle management. The CPB works closely with providers, coders, and administrative staff to resolve billing issues, reduce denials, and maximize reimbursement while maintaining accurate documentation and compliance standards.
Key Responsibilities:
- Prepare, review, and submit accurate medical claims to insurance payers in a timely manner.
- Verify billing data for completeness and accuracy, including diagnosis codes, procedure codes, modifiers, and patient demographics.
- Monitor claim status and follow up with insurance companies regarding unpaid, rejected, or denied claims.
- Investigate and resolve claim denials, rejections, and underpayments.
- Post insurance payments, adjustments, and patient payments accurately in the billing system.
- Review explanation of benefits (EOBs) and electronic remittance advice (ERAs) for accuracy.
- Communicate with patients regarding billing questions, insurance coverage, and outstanding balances when necessary.
- Work closely with coding and clinical staff to resolve documentation or coding discrepancies.
- Maintain compliance with payer guidelines, billing regulations, and HIPAA requirements.
- Assist in identifying billing trends, errors, and opportunities to improve revenue cycle performance.
- Maintain accurate records of billing activities and claim follow-ups in the practice management system.
Performance Metrics (KPIs):
- Maintain a clean claim submission rate of 95% or higher.
- Ensure 95% of claims are submitted within 48–72 hours of charge entry.
- Maintain a claim denial rate below 5–7%.
- Support maintaining AR days under 35–40 days.
- Review and resubmit denied claims within 7–10 business days.
- Maintain 98–100% accuracy in payment posting and billing adjustments.
- Successfully resolve and recover payments from denied or underpaid claims.
- Ensure 100% compliance with billing documentation standards and regulatory requirements.
Requirements & Qualifications
- Certified Professional Biller (CPB) certification required (such as through AAPC).
- High school diploma required; associate degree in healthcare administration, billing, or related field preferred.
- 2–4 years of medical billing experience in a healthcare practice, hospital, or billing company preferred.
- Strong knowledge of CPT, ICD-10-CM, and HCPCS coding systems.
- Experience with insurance claims, EOBs, ERAs, and denial management.
- Proficiency with electronic health records (EHR) and practice management systems.
- Strong analytical, problem-solving, and organizational skills.
- Excellent communication and attention to detail.
- Medical billing experience: 2 years (required).
Benefits & Perks
- Health insurance
- Paid time off
Location
Virginia, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
3 weeks ago