The Certified Professional Biller (CPB) manages the full medical billing process to ensure accurate claim submission, timely reimbursement, and compliance with payer and regulatory requirements.

This role works closely with providers, coders, and administrative staff to resolve billing issues, reduce denials, maximize reimbursement, and maintain accurate documentation and compliance standards.

Key responsibilities

Prepare, review, and submit accurate medical claims to insurance payers.
Verify billing data for completeness and accuracy, including diagnosis codes, procedure codes, modifiers, and patient demographics.
Monitor claim status and follow up on 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 EOBs and ERAs for accuracy.
Communicate with patients regarding billing questions, insurance coverage, and outstanding balances when needed.
Work with coding and clinical staff to resolve documentation or coding discrepancies.
Maintain compliance with payer guidelines, billing regulations, and HIPAA requirements.
Identify billing trends, errors, and opportunities to improve revenue cycle performance.
Keep accurate records of billing activities and claim follow-ups in the practice management system.

Performance expectations

Maintain a clean claim submission rate of 95% or higher.
Submit 95% of claims within 48–72 hours of charge entry.
Keep claim denial rates below 5–7%.
Support accounts receivable days under 35–40.
Resubmit denied claims within 7–10 business days.
Maintain 98–100% accuracy in payment posting and adjustments.
Ensure full compliance with billing documentation standards and regulatory requirements.

Certified Medical Biller