Certified Professional Biller

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 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.