Medical Biller

We are seeking a detail-oriented and proactive Medical Biller to join our growing revenue cycle team in a value-based care environment. This role is responsible for accurate and timely claim submission, payment posting, and denial follow-up to ensure optimal reimbursement and compliance with payer guidelines. The ideal candidate has a strong understanding of both fee-for-service and risk-based payment models, thrives in a collaborative setting, and is passionate about supporting high-quality, patient-centered care through operational excellence.

What You’ll Do:

• Prepare, review, and submit clean medical claims for primary and secondary payers, including Medicare Advantage, Medicaid Managed Care, and commercial insurers.
• Verify patient insurance coverage and eligibility prior to billing.
• Post payments and adjustments accurately to patient accounts.
• Monitor and follow up on unpaid claims, rejections, and denials in accordance with payer guidelines.
• Research and resolve billing discrepancies, coordinate with clinical and administrative teams as needed.
• Assist in coding validation and documentation review to support accurate claims submission.
• Maintain a strong understanding of payer policies, VBC metrics, RAF/HCC coding relevance, and risk adjustment impacts on reimbursement.
• Support audits, data clean-up initiatives, and quality reporting related to billing.
• Communicate effectively with insurance carriers, patients, and internal departments to resolve billing issues.
• Ensure compliance with HIPAA and all regulatory requirements.

Qualifications:

• High school diploma or equivalent required; associate degree or billing certification (e.g., CPB, CMRS) preferred.
• 2 years of medical billing experience in a multi-specialty or primary care setting.
• Experience with Medicare Advantage, HMO, PPO, and/or value-based payment models strongly preferred.
• Familiarity with EMR and billing software (e.g., eClinicalWorks, Athena, NextGen, Kareo).
• Working knowledge of CPT, ICD-10, HCPCS, and modifier usage.
• Strong attention to detail, organizational skills, and follow-through.
• Excellent communication and teamwork skills.

Environmental Job Requirements and Working Conditions

• Our organization follows an in-person work structure where the expectation is to work onsite daily. This position will report to our corporate office at 8880 W Sunset Rd, Suite 320, Las Vegas, NV 89148.
• The total pay range for this role is: $20-23 per hour. This salary range represents our national target range for this role.