Essential Duties and Responsibilities
Revenue Cycle (Full Cycle, Front to Back)
• Own the full revenue cycle for the practice, front and back office — charge entry, check-in, claim creation, claim submission, payment posting, and AR workflows.
• Review claims for accuracy and identify billing issues prior to submission.
• Investigate and resolve claim rejections, denials, and underpayments; submit corrected claims and appeals as necessary.
• Review and work accounts receivable aging reports to ensure timely reimbursement.
• Serve as the primary point of contact for both patients and insurance payers — no external billing vendor hand-off.
Patient Billing & Collections
• Manage patient balances and collection activities in accordance with practice policies.
• Contact patients regarding outstanding balances and establish payment arrangements when appropriate.
• Process patient payments and maintain accurate, transparent account balances — no undisclosed charges or retroactive corrections to prior months’ billing.
• Reconcile payment discrepancies and research billing concerns.
• Maintain accurate financial documentation and patient account records.
Patient Financial Services & Customer Support
• Serve as the primary contact for the practice’s billing phone line.
• Answer patient questions regarding deductibles, copayments, coinsurance, eligibility/benefits, outstanding balances, payment arrangements, and billing statements/charges.
• Provide patients with copies of billing statements, itemized receipts, and payment histories upon request.
• Explain billing information clearly, professionally, and compassionately to patients and families.
• Resolve patient billing concerns promptly and escalate complex issues when necessary.
• Exceptional phone etiquette and customer service are required — the practice has had prior issues with unprofessional patient interactions, and this is a key hiring priority.
Reporting & Performance Monitoring
• Monitor and report on key revenue cycle metrics to management, including Days in AR, AR Aging, Clean Claim Rate, Claim Creation/Submission Lag, Payment Posting Timeliness, and Patient Collection Performance.
• Prepare and present clear reports for the CEO’s weekly billing meeting; strong working proficiency in Excel and PowerPoint is required to build these reports independently.
Compliance & Collaboration
• Maintain compliance with HIPAA, payer guidelines, and all applicable federal and state regulations. Candidate must hold a current HIPAA certification.
• Ensure billing documentation supports medical necessity and payer requirements.
• Collaborate effectively with the Practice Manager, administrative staff, and CEO to resolve billing-related concerns and improve operational processes.