Medical Biller I

Medical Biller I supports the billing and accounts receivable functions within Patient Financial Services. The role assists with basic billing tasks, claim processing, and follow-up activities under the guidance of senior staff. It works with patients, insurance payers, and internal departments to help ensure accurate account handling and a positive patient financial experience.

This position is designed to build foundational knowledge of hospital billing processes within a Critical Access Hospital environment.

Standard Expectations

• Promote a positive working environment by aligning with the organization’s mission, values, and standards of behavior.
• Accept change and challenges with a positive attitude.
• Consistently adhere to organizational policy.
• Communicate effectively with staff and supervisors.
• Perform duties efficiently and effectively in compliance with applicable federal, state, and local regulations.
• Perform other duties as assigned.

Duties and Responsibilities

Patient Interaction and Customer Service

• Serve as a point of contact for patient billing inquiries.
• Educate patients on financial responsibility, insurance coverage, and payment options.
• Direct complex patient concerns to senior staff.
• Support patients with payment options and financial assistance resources.

Billing and Claims Submission

• Assist with preparing and submitting claims under supervision.
• Review accounts for completeness and accuracy prior to claim submission.
• Identify and report claim edits, holds, or errors to senior billers.
• Support timely processing of primary and secondary claims.

Accounts Receivable and Payer Follow-Up

• Perform routine follow-up on outstanding claims.
• Review claim status using payer portals or internal systems.
• Assist in identifying unpaid or denied claims and follow workflows.
• Document account activity accurately and consistently.
• Contact payers for additional information by phone or portal.
• Research and resolve denials related to coordination of benefits, eligibility, patient questionnaires, and other common denials.
• Escalate complex reimbursement issues to leadership.

Denials Management and Revenue Protection

• Research and resolve basic denial categories such as eligibility, authorization, and billing errors.
• Identify and route complex denials to appropriate team members.
• Research and resolve hospital billing denials using Epic and internal workflows.
• Maintain clear and compliant account documentation within Epic.

Epic HB System Responsibilities

• Utilize Epic work queues and tools to complete assigned tasks.
• Maintain accurate account notes, claim statuses, and follow-up actions in Epic.
• Report system issues or workflow concerns to a supervisor.
• Follow established workflows for account handling.

Compliance, Audit, and Reimbursement Support

• Follow all applicable billing regulations and payer requirements.
• Maintain patient confidentiality in accordance with HIPAA.
• Adhere to hospital policies and compliance standards.
• Participate in training and skill development activities.

Team Support and Cross-Coverage

• Provide support to team members as needed.
• Participate in department meetings and training sessions.
• Demonstrate a willingness to learn billing processes and systems.
• Cross-train in basic functions within Patient Financial Services as assigned.