Sr Medical Biller Specialist

Infinit-O isn't just about business process optimization, we're about people. For over 20 years, we've been helping some of the world's fastest-growing companies in Financial Services, Healthcare, and Technology achieve multiple strategic advantages through data-driven solutions, high-performance teams, and cutting-edge technology. Our world-class Net Promoter Score of 75 reflects our commitment to excellence and client satisfaction.

But what truly sets us apart is our culture. At Infinit-O, diversity, equity, and inclusion are the foundation of innovation and sustainable growth. We embrace differences, empower perspectives, and create equal opportunities for everyone. Our people-first approach has earned us the

Great Place To Work Certification three times, and as a B Corp Certified company, we're dedicated to making a positive impact not just in business but in the communities we serve.

With a highly engaged and innovative team, we don't just optimize processes; we also create meaningful change.

We are seeking a highly skilled and experienced Medical Biller & Claims Specialist to join our team. The ideal candidate will be responsible for managing the full medical billing cycle, starting from the point of coded procedures within the Electronic Health Record (EHR) system. This role is critical to ensuring accurate claim submission, timely payment, and effective denial management, with a specific focus on navigating the complexities of Medicaid billing.

Key Responsibilities:

• Claim Generation and Submission:

• Retrieve coded procedures and patient data from the EHR system.

• Review claims for accuracy and completeness, verifying that all necessary information (patient demographics, provider details, coded procedures, diagnoses) is present and correct before submission.
• Prepare and submit electronic and paper claims to the relevant Medicaid payers and clearinghouses in a timely manner.

• Accounts Receivable (A/R) Management:

• Proactively monitor and follow up on the status of all submitted claims to ensure timely payment.

• Identify and resolve outstanding A/R balances by contacting Medicaid payers and investigating claim status.
• Analyze Explanation of Benefits (EOBs) and Remittance Advices (RAs) to understand payment details, denials, and rejections.

• Denial Management and Appeals:

• Investigate and triage denied or rejected claims to determine the root cause of the issue (e.g., coding errors, eligibility issues, timely filing).

• Correct and resubmit claims with corrected information.
• Prepare and submit formal appeals with supporting documentation for claims that are incorrectly denied.
• Maintain a detailed log of denial trends to identify and report systemic issues.

• Payment Posting and Reconciliation:

• Accurately post payments received from Medicaid payers to the appropriate patient accounts.

• Ensure all contractual adjustments and write-offs are applied correctly.
• Reconcile payment discrepancies and ensure account balances are accurate.

• Compliance:

• Maintain up-to-date knowledge of Medicaid billing regulations, coding guidelines, and state-specific policies.

• Ensure all billing and claims handling procedures are compliant with HIPAA and other relevant regulations.

Required Skills and Qualifications:

• Experience:

• Proven experience as a medical biller, with a minimum of 3+ years of hands-on experience in a dedicated claims and A/R follow-up role.

• Specific experience with Medicaid billing is essential. Knowledge of [Client's State] Medicaid program is highly preferred.
• Demonstrated success in reducing denial rates and improving collections.

• Technical Skills:

• Proficiency with various Electronic Health Record (EHR) and practice management systems.

• Familiarity with billing and clearinghouse software.
• Strong computer skills, including proficiency with Microsoft Office Suite (Excel).

• Knowledge:

• In-depth knowledge of the entire revenue cycle management process.

• Strong understanding of medical terminology, CPT, ICD-10, and HCPCS coding as they relate to claim review and denial management.
• Comprehensive knowledge of HIPAA and other healthcare compliance regulations.

• Soft Skills:

• Exceptional attention to detail and a high level of accuracy.

• Excellent analytical and problem-solving skills to effectively troubleshoot claim issues.
• Strong verbal and written communication skills for interacting with payers and internal staff.
• Ability to work independently, manage a high volume of claims, and meet deadlines.
• A proactive and persistent approach to A/R follow-up.