Medical Biller (Colorado Springs)

We are looking for a dedicated Billing Clerk to join our team in Colorado Springs, Colorado. In this role, you will play a vital part in ensuring accurate and efficient billing processes for a healthcare organization specializing in treatments for medication-resistant depression. The ideal candidate is detail-oriented, organized, and possesses excellent communication skills to maintain seamless workflows and patient satisfaction.

Job Description

As a Medical Biller, you will play a critical role in managing all aspects of the revenue cycle process. This position blends technical billing expertise with empathetic patient interaction, making it vital for ensuring the financial health of our organization while maintaining high-quality patient experiences.

Key Responsibilities

• Claim Management : Handle charge and code input, prior authorizations, scrubbing, timely submission of claims, secondary billing, and coordination of benefits.
• Payment Posting : Post patient and insurance payments using ERA and paper EOBs; identify payment discrepancies and patterns like downcoding or out-of-network adjustments by insurance companies.
• Appeals and Denials : Manage insurance denials through appeals and coordinate coverage by assessing patient eligibility and prior authorization details. Utilize portals such as Availity, Zelis, One Healthcare, Cigna HCP, Medicare/WPS, and others.
• Patient Interaction : Communicate with patients about copays, outstanding balances, payment plans, and refunds or credits, often engaging with individuals who may have severe depression.
• Communication Tracking : Document all communications with patients and insurance companies, ensuring HIPAA compliance.
• Reporting and Analysis : Generate and maintain reports from practice management systems like NextGen and update the billing escalation tracker in Excel (pivot table proficiency required).
• Audit Support : Assist with insurance and internal audits and handle accompanying records requests.
• Process Improvement : Identify opportunities to shift to automated processes wherever possible, including transitioning paper claims, checks, and EOBs to electronic formats.

Requirements Education & Experience

• High school diploma or equivalent (required); an associate degree or higher is preferred.
• Minimum of 2 years of experience in billing and coding, ideally at one location.

Certifications

• Certification as a Certified Professional Coder (CPC) or equivalent preferred.

Technical Skills

• Software Proficiency : Experience with electronic health records and practice management systems such as NextGen preferred. Familiarity with clearinghouses like Waystar is a plus.
• Excel Mastery : Strong Excel skills, including proficiency in pivot tables; certification in Excel is a bonus.
• Billing Knowledge : Background with payers like Tricare/Triwest, Blue Cross (Anthem), and VA benefits is advantageous.

Interpersonal Skills

• Ability to communicate with empathy and firmness, especially when creating patient payment plans, addressing billing issues, or working with patients with severe depression.
• Excellent verbal and written communication skills, paired with a commitment to customer service excellence.

Highly Preferred Skills & Experience

Candidates with direct experience in full revenue cycle management (RCM) are highly valued. This includes:

• Coding and billing for specialized services, such as SPRAVATO and TMS treatments.
• Working with both primary and secondary insurances, coordination of benefits, and insurance audit preparation.
• Knowledge of payer-specific processes, including denials, appeals, reference requests, and more.