Medical Biller

NW Medical Benefits; Portland (OR); On-site; USD 30,307 - 37,195; Full time

Job summary

A health services provider in Portland, OR, is seeking a Medical Biller to manage the full revenue cycle for their sleep center. The ideal candidate will have over 3 years of experience in medical billing with a preference for sleep medicine or durable medical equipment (DME). Proficiency in medical billing software, CPT and ICD-10 coding, and denial management strategies is required. This role offers a pay range of $22 to $27 per hour, generating a vital contribution to the financial health of the organization.

Qualifications

• 3+ years of experience in medical billing, preferably with sleep medicine.
• Certified Professional Biller (CPB) or Certified Professional Coder (CPC) is preferred.
• Proficient with medical billing software and understanding of relevant regulations.

Responsibilities

• Manage the full revenue cycle for sleep center billing.
• Accurately apply sleep-specific CPT and ICD-10 codes.
• Handle denial management and patient inquiries.

Skills

Sleep-Specific Coding

ICD-10 Proficiency

Denial Management

Patient Communication

Education

3+ years in medical billing

Certification as CPB or CPC

Tools

Athena

Job description

About Vancouver Sleep Center

At Vancouver Sleep Center, we know how stressful it can be when sleep feels out of reach. That’s why we’ve built our practice around experience, accessibility, and patient-focused care. Our board-certified sleep specialists have decades of experience helping people improve their sleep and feel better in their daily lives.

We guide you every step of the way, from detailed sleep consultations and in-depth studies to personalized treatment plans and medical equipment. As one of the sleep centers Portland, OR and the surrounding areas have relied on for decades, we understand how urgent sleep problems can be, so we strive to see new patients within a week of their first call.

Position Summary

The Medical Biller is responsible for ensuring the financial viability of the center by managing the full revenue cycle. This role requires a specialist who can navigate the unique coding requirements of polysomnography (PSG) and Home Sleep Apnea Testing (HSAT), ensuring that the 260+ monthly referrals are successfully billed, adjudicated, and collected.

Detailed Essential Functions

1. Claims Coding & Submission

• Sleep-Specific Coding: Accurately apply CPT codes (e.g., 95810, 95811, 95800, 95806) and appropriate modifiers (TC, 26, or 52) based on the service provided.
• ICD-10 Proficiency: Ensure primary diagnoses (like G47.33 for OSA) are supported by the technician’s findings and physician’s interpretation.
• Electronic Batching: Clean and submit electronic claims via the clearinghouse, maintaining a low "Clean Claim Rate" (CCR) of 95% or higher.

2. Payer-Specific Navigation

• Governmental Billing: Manage Medicare Part B claims and ensure compliance with Local Coverage Determinations (LCDs).
• Military Payers: Handle the unique "Authorization to Claim" matching required for TriWest (VA CCN) and TRICARE West.
• Commercial PPO/HMO: Resolve "Medical Necessity" denials by coordinating with the Referral Coordinator to provide retro-authorizations or clinical notes.

3. Accounts Receivable (A/R) & Appeals

• Denial Management: Identify patterns in denials and execute formal appeals (Level 1 and Level 2) with clinical evidence.
• Patient Statements: Generate monthly statements and handle patient inquiries regarding high-deductible plans or co-insurance for sleep studies.
• Payment Posting: Accurately post ERAs (Electronic Remittance Advice) and manual checks, reconciling bank deposits with EMR reports.

Technical Competencies

• Credentialing: Assist in maintaining provider enrollment with Medicare and commercial panels.
• Audit Compliance: Ensure all "Direct Sleep Study" referrals have a signed order and documented face-to-face visit to prevent "clawbacks."
• Financial Reporting: Provide weekly "Aging Reports" (30, 60, 90+ days) to management.

Qualifications

• Experience: 3+ years in medical billing; Sleep Medicine or DME experience is strongly preferred.
• Certification: CPB (Certified Professional Biller) or CPC (Certified Professional Coder) preferred.
• Software: Proficiency with medical billing software (Athena) and clearinghouses.
• Knowledge: Deep understanding of the No Surprises Act and Washington state-specific billing regulations.

Success Metrics (KPIs)

• Days in A/R: Target < 35 days.
• Clean Claim Rate: > 95%.
• Denial Rate: < 5%.

The pay range for this role is: 22 - 27 USD per hour (Mill Plain)