Certified Medical Biller (Outpatient Rheumatology Practice)
15 days ago
Orange Park
Job Description Position: Medical Biller Location: In-person (Orange Park area), Remote, or Hybrid (blend of both) Reports To: Practice Manager / Physician-Owner Employment Type: Full-time About Us We are a small but growing outpatient rheumatology practice dedicated to delivering compassionate, high-quality care for patients with arthritis, autoimmune, and musculoskeletal conditions. We strive to provide a professional, team-oriented environment that balances clinical excellence with efficiency and compliance. Position Summary The Certified Medical Biller will oversee all aspects of rheumatology billing operations, including insurance claims submission, payment posting, patient billing, and reconciliation of accounts. This role requires certification in rheumatology billing and strong knowledge of payor rules, Medicare, infusion and injection coding, and compliance requirements. The role is flexible and may be performed in person, remotely, or as a hybrid arrangement depending on practice needs. Key Responsibilities * Claims Management * Prepare, review, and submit accurate electronic and paper claims for office visits, diagnostic services, infusion therapy, and specialty procedures. * Ensure claims are coded correctly according to CPT, HCPCS, and ICD-10 guidelines with attention to rheumatology-specific coding rules. * Monitor clearinghouse rejections, denials, and appeals in a timely manner. * Posting & Reconciliation * Post insurance payments, adjustments, and patient payments into the practice management system. * Reconcile daily deposits against EOBs, ERAs, and practice financial reports. * Investigate and resolve payment discrepancies. * Patient Billing & Support * Generate and distribute patient statements, handle billing inquiries, and set up payment arrangements as needed. * Provide clear and professional communication to patients regarding balances, insurance issues, and coverage questions. * Compliance & Reporting * Maintain current knowledge of rheumatology billing guidelines, Medicare rules, and payer policies. * Prepare monthly reconciliation reports and billing performance metrics for management review. * Ensure HIPAA and OIG compliance in all billing activities. Qualifications * Required: * Certification in Rheumatology Billing (e.g., RBS – Rheumatology Billing Specialist, or equivalent recognized certification). * Minimum of 2 years’ experience in medical billing, with preference for rheumatology, infusion, or specialty practice billing. * Strong knowledge of CPT, ICD-10, HCPCS, Medicare guidelines, and infusion billing compliance. * Proficiency with practice management/EMR systems (experience with eClinicalWorks, or similar preferred). * Detail-oriented with excellent organizational and reconciliation skills. * Strong communication skills for interaction with patients, staff, and payers. * Preferred: * Experience in a small outpatient specialty practice setting. * Familiarity with QuickBooks or accounting reconciliation workflows. Work Environment & Schedule * Flexible work arrangement: on-site, remote, or hybrid. * Full-time position with standard office hours Monday–Friday (occasional overtime may be needed for month-end reconciliation). * Collaborative, team-oriented environment with physician-led leadership. Compensation & Benefits * Competitive hourly or salary compensation (commensurate with experience and certification). * Retirement Plan: 401(k) with employer contribution. * Health insurance and PTO package available. * Opportunities for continuing education in specialty medical billing.