Medical Biller - Plastic Surgery (AR & Denial Management Focus)
Position Overview
We are seeking a detail-oriented and experienced Medical Biller with a strong background in plastic surgery billing and insurance follow-ups. The ideal candidate has hands-on experience handling Anthem BCBS claims, denial management, and preventing recoupments. This role requires strong analytical skills, persistence in AR follow-ups, and accuracy in claims processing.
This is a critical role that directly impacts revenue cycle performance and reimbursement timelines.
Requirements
Key Responsibilities
Claims Processing & Submission
- Submit accurate and timely claims for plastic surgery procedures
- Review documentation for coding and billing accuracy
- Ensure proper modifier usage when applicable
Insurance Verification & Payer Communication
- Work extensively with Anthem BCBS
- Verify benefits and confirm coverage for procedures
- Communicate with insurance representatives regarding claim status
Denial Management
- Analyze denied claims and identify root causes
- Prepare and submit appeals with supporting documentation
- Track and resolve denied and rejected claims promptly
Accounts Receivable (AR) Management
- Follow up on outstanding claims
- Monitor aging reports
- Reduce AR days through consistent follow-ups
Required Experience
- Proven experience in plastic surgery billing
- Strong experience handling Anthem BCBS claims
- Hands-on experience with claims denial management
- Experience preventing and managing recoupments
- Proficient in:
- Availity
- Practice Fusion
Technical Skills
- Strong knowledge of CPT, ICD-10, and HCPCS coding
- Understanding of payer guidelines and insurance workflows
- Ability to interpret EOBs and ERA reports
- Experience working AR aging reports
Soft Skills
- Detail-oriented and highly organized
- Strong problem-solving skills
- Excellent communication skills (written and verbal)
- Ability to work independently and meet productivity targets
Performance Expectations
- Maintain clean claims submission rate
- Reduce denial percentage
- Improve AR turnaround time
- Minimize recoupments through proactive review