Rheumatology Medical Biller - PT / FT

Arthritis & Osteoporosis Treatment; Orange Park (FL); On-site; USD 55,000 - 75,000; Full time

Job summary

Arthritis & Osteoporosis Treatment is seeking an experienced Rheumatology Medical Biller to join our physician-owned practice. The role covers the full revenue-cycle, with emphasis on accurate billing for office visits, procedures, injections, infusions, and specialty medications.

The ideal candidate will have strong CPT/HCPCS knowledge, experience with eClinicalWorks (eCW), and a detail-oriented approach to resolve discrepancies and maximize reimbursement.

Qualifications

• Prior medical billing/revenue-cycle experience required.

Responsibilities

• Review and submit professional claims for office visits, procedures, injections, infusions, and medications.
• Review charges for accuracy, including CPT/HCPCS codes, units, modifiers, diagnosis codes, and payer-specific billing requirements.
• Ensure infusion/injection medications and administration services are accurately captured and billed.
• Review documentation and identify potential coding or charge discrepancies before claim submission.
• Post insurance payments, ERAs/EOBs, adjustments, denials, and patient responsibility accurately in eCW.
• Reconcile posted payments to EOBs/ERAs and identify posting discrepancies.
• Work clearinghouse rejections and claim edits promptly.
• Review unpaid and underpaid claims and perform appropriate follow-up with payers.
• Work denials, corrected claims, reconsiderations, and appeals through resolution.
• Monitor accounts receivable and prioritize aging and high-dollar accounts.
• Research payer policies, LCD/NCD requirements, authorization issues, coding requirements, and reimbursement discrepancies as needed.
• Review infusion and specialty medication claims for correct drug codes, units, administration codes, diagnosis support, and reimbursement.
• Assist with buy-and-bill medication reconciliation and identification of missed or incorrect charges.
• Identify trends in denials, coding errors, payment discrepancies, or workflow failures and escalation concerns appropriately.
• Maintain clear documentation of billing follow-up and actions taken.
• Assist with patient account questions and insurance-related billing issues as needed.

Skills

Medical billing

Revenue cycle

CPT/HCPCS knowledge

Payer follow-up

Tools

eClinicalWorks (eCW)

Job description

Job Description

Rheumatology Medical Biller

We are an independent physician-owned rheumatology practice, is seeking an experienced Medical Biller to join our team.

We are looking for someone who is detail-oriented, organized, accountable, and comfortable working across the full revenue cycle. Rheumatology, infusion, specialty medication, and eClinicalWorks (eCW) experience are strongly preferred.

This is a hands-on role requiring someone who can identify problems, research discrepancies, follow issues through resolution, and help ensure that services provided are accurately billed and reimbursed.

Key Responsibilities

• Review and submit professional claims for office visits, procedures, injections, infusions, and medications.
• Review charges for accuracy, including CPT/HCPCS codes, units, modifiers, diagnosis codes, and payer-specific billing requirements.
• Ensure infusion/injection medications and administration services are accurately captured and billed.
• Review documentation and identify potential coding or charge discrepancies before claim submission.
• Post insurance payments, ERAs/EOBs, adjustments, denials, and patient responsibility accurately in eCW.
• Reconcile posted payments to EOBs/ERAs and identify posting discrepancies.
• Work clearinghouse rejections and claim edits promptly.
• Review unpaid and underpaid claims and perform appropriate follow-up with payers.
• Work denials, corrected claims, reconsiderations, and appeals through resolution.
• Monitor accounts receivable and prioritize aging and high-dollar accounts.
• Research payer policies, LCD/NCD requirements, authorization issues, coding requirements, and reimbursement discrepancies as needed.
• Review infusion and specialty medication claims for correct drug codes, units, administration codes, diagnosis support, and reimbursement.
• Assist with buy-and-bill medication reconciliation and identification of missed or incorrect charges.
• Identify trends in denials, coding errors, payment discrepancies, or workflow failures and escalation concerns appropriately.
• Maintain clear documentation of billing follow-up and actions taken.
• Assist with patient account questions and insurance-related billing issues as needed.
• Follow established compliance, documentation, and revenue-cycle policies and procedures.
• Collaborate with providers, nurses, front-office staff, authorization staff, and management to resolve billing issues.

Qualifications

• Prior medical billing/revenue-cycle experience required.
• Rheumatology, infusion, injection, or specialty medication billing experience strongly preferred.
• Experience with physician-administered buy-and-bill medications highly preferred.
• Working knowledge of CPT, HCPCS, ICD-10-CM, modifiers, Medicare and commercial payer billing requirements.
• Experience with charge entry/review, payment posting, ERA/EOB processing, denials, appeals, and accounts receivable.
• eClinicalWorks (eCW) experience strongly preferred.
• Experience with Medicare LCD/NCD requirements and medical-necessity review preferred.
• CPC, CPB, or other coding/billing certification is a plus but not required with strong applicable experience.

What We Are Looking For

The ideal candidate:

• Has exceptional attention to detail and catches discrepancies before they become larger problems.
• Understands that a paid claim is not necessarily an accurately billed claim.
• Is comfortable researching unfamiliar billing or payer issues rather than simply passing them along.
• Takes ownership of issues and follows them through resolution.
• Can manage multiple priorities and high-dollar claims without losing track of follow-up.
• Communicates clearly with clinical and administrative staff.
• Recognizes patterns and proactively identifies opportunities to improve workflows.
• Is dependable, organized, and able to work independently while functioning as part of a team.
• Is comfortable learning the complexities of rheumatology medications and payer requirements.

Preferred Experience

Experience with rheumatology and medications such as biologic infusions/injections, osteoporosis therapies, or other physician-administered specialty medications is highly desirable. Familiarity with Medicare, Medicare Advantage, commercial insurance, specialty pharmacy/white-bagging issues, prior authorizations, and specialty-drug reimbursement is also beneficial.