Senior Billing Representative

ADP, Inc.; Plymouth (MA); On-site; USD 33,000 - 50,000; Full time

Job summary

ADP, Inc. in Plymouth, MA, is seeking a Senior Medical Billing Representative to maximize reimbursement and ensure compliance across the revenue cycle.

You will serve as a subject matter expert in medical billing, denial management, and AR follow-up while collaborating with providers, payors, patients, and internal teams. The role requires several years of billing experience, strong coding knowledge, and mentoring abilities.

Qualifications

• Strong knowledge of medical terminology, ICD-10 and CPT coding.
• Experience with denial management, appeals, and follow-up.
• Able to mentor team members.
• HIPAA and privacy compliance knowledge.

Responsibilities

• Review and resolve complex claim edits and billing discrepancies.
• Perform advanced accounts receivable follow-up on unpaid/denied claims.
• Analyze denial trends and implement corrective actions.
• Prepare appeals with supporting medical records.
• Ensure timely filing requirements are met.

Skills

Medical Billing

Revenue Cycle Management

Denial Management

Communication Skills

Attention to Detail

HIPAA Compliance

Education

Associate's or Bachelor's degree

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Plymouth, MA, US

Salary Range: $24.00 To $36.00 Hourly

Senior Medical Billing Representative

Drive Revenue Cycle Excellence. Make a Direct Impact on Patient Care.

Are you a seasoned medical billing professional who thrives on solving complex challenges, improving processes, and mentoring others? We're looking for a Senior Medical Billing Representative to join our team and play a key role in maximizing reimbursement, ensuring compliance, and supporting operational excellence across the revenue cycle. In this highly visible role, you'll serve as a subject matter expert in medical billing, denial management, and accounts receivable follow-up while collaborating closely with providers, payors, patients, and internal teams. If you're passionate about revenue cycle performance, continuous improvement, and delivering exceptional results, we'd love to hear from you.

This is a fulltime opportunity: M-F, 8-4:30PM in our Plymouth location.

What You'll Do

• Review, investigate, and resolve complex claim edits, rejections, and billing discrepancies.
• Perform advanced accounts receivable follow-up on unpaid, underpaid, and denied claims.
• Analyze denial trends and implement corrective actions to improve reimbursement outcomes.
• Prepare and submit detailed appeals supported by medical records, documentation, and payor guidelines.
• Ensure claims and appeals meet all timely filing requirements.

Optimize Revenue Cycle Performance

• Verify and maintain accurate patient demographics, insurance information, charges, and coding updates.
• Monitor insurance eligibility, benefits, authorization requirements, and referral needs.
• Review medical documentation to ensure compliance with payor medical necessity policies.
• Process authorization requests and track approvals for procedures and services.
• Manage patient and insurance refund requests and monitor self-pay balances.
• Coordinate collection activities and agency placements when appropriate.

Serve as a Billing Subject Matter Expert

• Provide guidance and support to team members regarding billing processes, coding, denials, and payor requirements.
• Act as a key resource for resolving escalated billing inquiries and complex account issues.
• Build productive relationships with insurance carriers, physician offices, patients, and internal departments.
• Assist with onboarding and training new team members.
• Identify trends impacting reimbursement and recommend process enhancements.
• Stay current on healthcare regulations, billing guidelines, and payor policy changes.
• Communicate industry and regulatory updates to the billing team to ensure compliance and best practices.

Required Qualifications

• Strong knowledge of medical terminology, ICD-10 diagnosis coding, and CPT procedure coding.
• Advanced understanding of coding modifiers and their appropriate application.
• Several years of experience in medical billing, revenue cycle management, or accounts receivable operations.
• Proven success in denial management, appeals, and insurance follow-up.
• Strong analytical and problem-solving skills with exceptional attention to detail.
• Excellent communication and customer service abilities.
• Ability to prioritize multiple responsibilities in a fast-paced environment.
• Working knowledge of insurance eligibility, benefit verification, reimbursement methodologies, and referral requirements.
• Understanding of HIPAA regulations and compliance standards.
• Proficiency with Microsoft Office applications, including Word, Excel, and Outlook.

Preferred Qualifications

• Associate's or Bachelor's degree.
• Professional certification such as:
  • Certified Professional Coder (CPC)
  • Certified Ophthalmology Professional Coder (COPC)
• Experience in ophthalmology or a specialty medical practice setting.

Why Join Our Team?

At our organization, you'll have the opportunity to:

• Make a meaningful impact on financial performance and patient experience.
• Work alongside experienced healthcare professionals in a collaborative environment.
• Share your expertise while helping develop and mentor team members.
• Contribute to process improvements that enhance efficiency and revenue cycle success.
• Grow your career with a team that values accuracy, accountability, and continuous learning.