Hiring Medical Biller & Revenue Cycle Specialist @GoLean Health

Role Description We are seeking an experienced Medical Biller & Revenue Cycle Specialist to support a nonprofit behavioral health organization in the United States. This is an experienced-level position for someone who can independently oversee and strengthen the clinic's medical billing and revenue cycle processes. The Medical Biller will Review clinician-entered documentation, billing codes, charge information, and charge slips for completeness and accuracy before claims are processed. Identify missing, inconsistent, or potentially incorrect billing information that could affect claim acceptance or reimbursement. Coordinate with clinicians or appropriate team members when documentation, coding, or charge information requires correction or clarification. Review applicable ICD-10, CPT, HCPCS, and modifier information for consistency with documented services. Identify coding or documentation issues that may contribute to claim rejection, denial, underpayment, or compliance concerns. Apply strong coding knowledge to validate clinician-entered information while following established clinic and payer requirements. Compile and validate patient, provider, payer, diagnosis, procedure, and service information required for claim submission. Submit complete claims through AdvancedMD, clearinghouse workflows, or applicable payer processes in a timely manner. Monitor submission confirmations and promptly correct claims that are rejected before or during payer processing. Monitor submitted claims throughout the payer adjudication process for approval, rejection, denial, underpayment, or other outcomes. Review payer responses and determine what action is necessary to move unresolved claims toward payment. Maintain accurate documentation of claim status, payer communication, corrective actions, and next steps. Research denied or rejected claims to determine root cause and identify the appropriate corrective action. Resubmit corrected claims or prepare reconsiderations and appeals with the necessary supporting documentation. Track outstanding denials and appeals through resolution while identifying recurring issues that should be prevented in future claims. Review and prioritize outstanding Accounts Receivable based on aging, payer, claim status, value, and urgency. Follow up directly with insurance companies regarding unpaid, delayed, incorrectly processed, or unresolved claims. Monitor timely filing and appeal deadlines to reduce avoidable revenue loss. Post insurance payments, contractual adjustments, deductibles, copays, coinsurance, and other applicable amounts accurately. Reconcile payments and adjustments against EOBs, ERAs, and available payer information. Investigate underpayments, overpayments, posting discrepancies, or unexpected reimbursement differences. Review remaining patient responsibility after insurance adjudication and confirm that patient balances are accurate. Generate or validate patient statements and support established payment-plan or online payment processes when required. Respond professionally to patient billing inquiries and explain account information within the appropriate scope of the role. Assist with new provider payer enrollment, credentialing applications, attestations, and required supporting documentation. Monitor credentialing applications, payer responses, recredentialing requirements, and expiration dates. Follow up with insurance plans regarding pending applications or outstanding enrollment requirements. Monitor key revenue-cycle indicators including denial rates, Days in Accounts Receivable, AR aging, outstanding claims, and collection performance. Prepare billing and claims status reports and identify payer, denial, reimbursement, or workflow trends requiring attention. Communicate significant findings and recommend actions that may improve reimbursement and revenue-cycle performance. Conduct internal reviews of billing activity to identify errors, documentation problems, compliance concerns, and workflow gaps. Review recurring billing or payer issues that may be contributing to unnecessary denials, delayed payment, or revenue loss. Help ensure billing activities follow applicable clinic procedures, payer requirements, HIPAA standards, and healthcare regulations. Analyze recurring billing, coding, documentation, AR, and payer issues to identify their underlying causes. Recommend workflow improvements that may reduce errors, improve collections, and create more consistent billing performance. Proactively bring billing concerns and improvement opportunities to clinic leadership rather than waiting for problems to escalate. Document workflows for charge review, claim submission, denials, AR follow-up, appeals, and payment posting. Help establish standardized procedures for credentialing, billing reporting, patient balances, and internal audits. Update billing SOPs as payer requirements, clinic .