About the Role We're looking for a detail-oriented Medical Biller & Prior Authorization Specialist to join our team. In this dual role, you'll manage the full billing cycle while also securing prior authorizations to ensure patients receive timely, uninterrupted care. This is a great fit for someone who thrives on accuracy, enjoys problem-solving with payers, and wants to make a direct impact on both patient experience and practice revenue. What You'll Do Medical Billing Prepare, review, and submit accurate claims to insurance payers (commercial, Medicare, Medicaid) using CPT, HCPCS, and ICD-10 codes Post payments, adjustments, and denials; reconcile accounts and identify discrepancies Follow up on unpaid or denied claims, submit appeals with appropriate documentation Monitor accounts receivable and flag aging balances for escalation Maintain compliance with payer guidelines, HIPAA, and coding/billing regulations Communicate with patients regarding balances, statements, and payment plans as needed Prior Authorization Initiate, track, and follow up on prior authorization requests for medications, procedures, imaging, and referrals Review clinical documentation to ensure authorization requests meet payer medical necessity criteria Communicate with providers, clinical staff, and payers to gather required information and resolve authorization delays Maintain accurate, up-to-date records of authorization status in the practice management/EHR system Proactively identify services likely to require authorization and initiate requests ahead of scheduled care Stay current on payer-specific authorization requirements and policy changes

What We're Looking For Required:

1+ years of experience in a healthcare setting Proficiency with EHR/practice management systems (e.g., Epic, Athenahealth, eClinicalWorks, or similar)

Preferred:

Certified Professional Biller (CPB), Certified Coding Associate (CCA), or similar certification Experience in prior authorization management Working knowledge of CPT, HCPCS, and ICD-10 coding Familiarity with major payer portals and prior authorization submission processes Strong understanding of HIPAA and PHI handling requirements Excellent attention to detail and organizational skills Strong written and verbal communication skills, including comfort with payer phone calls and appeals

Pay:

$20.00 - $40.00 per hour

Benefits:

Paid time off Application Question(s): Do you have a certification in medical billing? If so, when did you get your certification? Do you have experience with prior authorizations? If so, please explain your workflow.

Work Location:

In person