Sr. Medical Biller – Revenue Cycle Management – End to End

Essential Duties and Responsibilities include the following.
Other duties may be assigned.

Revenue Cycle Management – End to End

• Handle full-cycle billing:
  Authorization/Utilization Review, eligibility checks, charge entry, claims submission, payment posting, AR follow-up, denial management, and patient collections.
• Utilize Tebra for all billing, claims, reports, corrections, and workflow management.
• Ensure timely and accurate claims submission to commercial payers, Medicare, and Medicaid.
• Review clinical documentation for wound care coding accuracy,
• Apply correct CPT/ICD-10 codes, modifiers, wound measurements, and medical necessity criteria.

Claims Management & AR

• Track and capture all visits/services to ensure complete and accurate billing.
• Review, submit, and process all medical bills and claims to insurance companies and government programs.
• Verify accuracy of demographic, insurance, and billing information prior to claim submission.
• Proactively follow up for timely payment and resolve unpaid claims, denials, discrepancies, and rejections.
• Generate and analyze aging reports, AR summaries, and denial trends.
• Monitor timely filing limits and ensure adherence to payer guidelines.
• Reconcile patient accounts and generate accurate patient statements.
• Process patient responsibilities, statements, payment plans, and outstanding balances.
• Maintain organized billing and financial records.
• Balance financial records daily, weekly, and monthly.
• Generate month-end reports, reconcile accounts, and submit financial summaries to leadership.

Provider & Insurance Coordination

• Communicate with providers regarding missing documentation, wound measurements, and coding clarifications.
• Coordinate with insurers, clearinghouses, and payers for claim resolution or benefit clarification.
• Assist with obtaining insurance pre-authorizations and pre-certifications as needed. Support continuous improvement of billing workflows and documentation accuracy.

Compliance & Reporting

• Maintain HIPAA compliance and adhere to payer guidelines.
• Generate RCM performance reports, including AR aging, denial trends, and reimbursement analysis.
• Identify process gaps and recommend best practices to enhance RCM efficiency

Key Qualifications:

• 5-10 + years of experience in Revenue Cycle Management
• Experience with wound care billing is a “nice to have”
• College degree or equivalent;
  Healthcare Administration or related field preferred.
• Advanced proficiency in Tebra for billing and RCM functions (required).
• Strong understanding of:
  • CPT/ICD-10 codes related to wound care
  • Medical necessity rules and documentation requirements
  • Facility vs. office wound care billing differences
  • AR/Claims management and denial resolution
  • Handling high-volume wound care encounters
• Strong analytical, communication, and organizational skills.
• High level of accuracy, attention to detail, and ability to work independently.
• Experience with US payer processes (commercial, Medicare, Medicaid).

Shift / Hours:

Monday – Friday from 8:00 AM PST – 5:00 PM PST in one single shift.. Note this is +13 or +14 Philippine Jeffe, which will be 8:00 PM PHT – 5:00 AM in PHT.

Business Overview:

The practice has 3 locations in Northern California specializing in wound care.