Medical Biller

Agility Billing Services, LLC; Town of Islip (NY); Hybrid; USD 70,000 - 95,000; Full time

Benefits offered by this job

Competitive compensation

Opportunities for professional development

Supportive work environment

Hybrid position after probation

Job summary

A medical billing service provider is seeking an Accounts Receivable Team Lead for commercial claims in the Town of Islip. The ideal candidate will have strong experience in collections and medical billing, including a solid understanding of Medicare and commercial insurance. Responsibilities include monitoring claims, appealing denials, and collaborating with teams to ensure timely reimbursement. A supportive work environment with competitive compensation and a hybrid position available after probation is offered.

Qualifications

• Experience in medical claims follow-up with good understanding of commercial and Medicare plans.
• Ability to review EOBs, denials, and payer communications.
• Prior experience in orthopedic, spine, or pain management services is preferred.
• Escalation point for complex, high-dollar or unresolved claims from AR team.

Responsibilities

• Monitor outstanding commercial and Medicare claims and provide advanced support.
• Review, appeal, and resolve complex claim denials and discrepancies.
• Collaborate with teams for accurate documentation and billing practices.
• Collaborate with clinical and administrative teams for accurate billing.
• Maintain organized records of claim activity and insurance correspondence.

Skills

Knowledge of commercial and Medicare insurance

Experience with out-of-network billing

Communication skills

ICD-10, CPT, and modifier usage

Problem-solving skills

Organizational skills

Self-motivation

Education

High school diploma or equivalent

Medical billing or coding certification

Associate’s degree in Health Information Technology

Job description

Overview

At Agility Billing Services, we are dedicated to providing exceptional care and service in the orthopedic and pain management field. We are seeking a skilled and motivated Accounts Receivable Team Lead for commercial claims to join our team. The ideal candidate will have significant experience in collections, medical billing, and a strong understanding of commercial insurance carriers and Medicare.

Position Overview: We are seeking a Team Lead for Commercial and Medicare Claims AR Follow-Up to join our team and support billing and collections for a busy surgical practice. The ideal candidate will have experience in medical claims follow-up, with a strong understanding of commercial and Medicare insurance plans and out-of-network billing. Prior experience in orthopedic, spine, or pain management services is highly preferred.

Qualifications:

• Working knowledge of commercial and Medicare insurance, including plan guidelines
• Experience with out-of-network billing processes; understanding of the IDR process and appeals is a plus
• Ability to review EOBs, denials, and payer communications to ensure timely appeals and maximize revenue capture
• Serve as an escalation point for complex, high-dollar, or unresolved commercial and Medicare claims from the AR team
• Excellent communication skills, particularly when working with insurance representatives and internal teams
• Proficient in ICD-10, CPT, and modifier usage
• Experience billing for orthopedic, spine, or pain management services is preferred but not required
• Strong problem-solving and organizational skills
• Self-motivated with the ability to work independently and meet deadlines

Key Responsibilities:

• Monitor, review, and follow up on outstanding commercial and Medicare claims, providing advanced support and serving as an escalation resource for unresolved, unpaid, or underpaid claims to ensure timely reimbursement
• Review, appeal, and resolve complex claim denials or payment discrepancies, including escalated issues from the AR team, using payer portals and payer communications
• Maintain up-to-date knowledge of payer policies (including LCDs), billing regulations, and coding guidelines
• Collaborate with clinical and administrative teams to ensure accurate documentation and billing practices
• Maintain organized and detailed records of claim activity, account status, and insurance correspondence

Education and Experience:

• High school diploma or equivalent required
• Medical billing or coding certification is a plus
• Associate’s degree in Health Information Technology or a related field preferred

Benefits:

• Competitive compensation based on experience, skills, and growth potential
• Opportunities for professional development and advancement in a specialty billing role
• Supportive, team-oriented work environment
• Hybrid position available after a 90-day probationary period