Medical Biller, Prior Authorization and Revenue Cycle Specialist
Location: Neurology Clinic of Folsom – A VerityMD Practice
193 Blue Ravine Road, Folsom, California
Position Summary
VerityMD Inc. is a growing, physician-led neurology practice seeking an experienced, dependable, and highly organized Medical Biller, Prior Authorization and Revenue Cycle Specialist for our Folsom location.
This is a hands-on position for someone who can independently manage the day-to-day revenue cycle needs of a four-provider specialty practice. The role includes insurance verification for approximately 50 new referrals each day, processing approximately 80 daily charges, prior authorizations, claim submission, payment posting, denial follow-up, accounts receivable, credentialing, and staff training.
Our practice currently uses Tebra for billing and revenue cycle workflows. The ideal candidate should have experience with Tebra or similar practice-management and billing systems and, more importantly, be comfortable learning new technology and adapting to new systems as the practice grows.
The specialist will work closely with our providers, front-office staff, calling team, and clinical team to ensure patients are financially cleared before scheduling, charges are entered correctly, claims are paid promptly, and authorization-related delays are minimized.
Experience assisting with payroll, invoice tracking, vendor payments, or basic practice financial administration would be an additional advantage.
Key ResponsibilitiesInsurance Verification and Referral Clearance
- Review approximately 50 new patient referrals each business day.
- Verify insurance eligibility, benefits, network status, referral requirements, and authorization requirements before appointments are scheduled.
- Confirm that VerityMD, the Folsom location, and the appropriate provider participate with the patient’s insurance plan.
- Identify patients who require referrals, authorizations, or additional documentation before scheduling.
- Clearly communicate scheduling eligibility and insurance requirements to the calling and scheduling teams.
- Document insurance verification findings accurately in the practice-management system.
- Contact insurance companies, medical groups, referring offices, or patients when additional information is needed.
- Help prevent scheduling errors, authorization delays, and avoidable patient billing concerns.
Charge Entry, Billing and Coding
- Review and process approximately 80 provider charges each business day.
- Verify that diagnoses, procedure codes, modifiers, units, provider information, and place-of-service information are accurate.
- Confirm that provider documentation supports the services billed.
- Review charge capture and promptly follow up with providers or staff regarding missing or incomplete information.
- Submit clean claims through Tebra and applicable clearinghouse systems.
- Monitor claim edits, rejections, and billing work queues.
- Correct rejected or incomplete claims promptly.
- Ensure claims are submitted within payer timely-filing limits.
- Maintain knowledge of ICD-10, CPT, HCPCS, modifier, and payer-specific billing requirements.
Prior Authorization Management
- Complete and track prior authorizations for medications, imaging, procedures, diagnostic testing, infusions, and specialty neurology services.
- Manage authorizations for services such as Botox, Leqembi, Ocrevus, IVIG, PET imaging, EEG, ambulatory EEG, EMG, autonomic testing, and other neurological procedures.
- Review clinical documentation and submit the information required to demonstrate medical necessity.
- Follow up consistently with insurance companies until a determination is received.
- Record authorization numbers, approved dates, approved units, and payer-specific restrictions in the appropriate system.
- Monitor authorization expiration dates and remaining approved units.
- Address authorization denials through reconsiderations, appeals, corrected submissions, or coordination of peer-to-peer reviews.
- Communicate authorization status clearly to providers, clinical staff, scheduling staff, and patients when appropriate.
- Help prevent treatment delays and services being performed without valid authorization.
Payment Posting and Account Reconciliation
- Review and reconcile electronic remittance advice payments.
- Post payments and adjustments manually when electronic posting is unavailable.
- Confirm that contractual adjustments and patient-responsibility amounts are applied correctly.
- Identify underpayments, incorrect adjustments, duplicate payments, and payment discrepancies.
- Reconcile payments with deposits and billing reports.
- Correctly transfer balances between insurance and patient responsibility.
- Assist with resolving complex patient account and billing questions.
Denial Management and Accounts Receivable
- Review claim denials and unpaid claims regularly.
- Determine the underlying cause of denials and take the appropriate corrective action.
- Submit corrected claims, reconsiderations, appeals, and supporting documentation within payer deadlines.
- Follow up on aging claims and outstanding balances.
- Identify recurring denial patterns involving coding, eligibility, authorizations, referrals, provider enrollment, or documentation.
- Recommend practical workflow changes to prevent repeat denials.
- Follow up on underpaid claims and ensure contracted reimbursement is received.
- Maintain clear documentation of all payer communication and follow-up activity.
Credentialing and Payer Enrollment
- Assist with provider credentialing and enrollment with Medicare, commercial insurance plans, medical groups, hospitals, and other healthcare organizations.
- Maintain accurate provider information in CAQH and payer portals.
- Track credentialing applications, revalidations, expirations, demographic updates, and payer requests.
- Follow up with payers until applications and updates are completed.
- Assist with adding new providers, practice locations, and services to payer contracts.
- Maintain organized credentialing and enrollment records.
Staff Training and Workflow Support
- Train front-office, scheduling, calling, and clinical staff on insurance verification, referral requirements, prior authorizations, charge capture, and billing-related workflows.
- Educate staff on common registration and insurance errors that can lead to denials or payment delays.
- Provide providers with practical feedback regarding documentation, coding, modifiers, and charge capture.
- Create and maintain simple written workflows, checklists, and reference guides.
- Help team members use Tebra and other practice systems correctly.
- Serve as a knowledgeable resource for day-to-day billing, authorization, insurance, and reimbursement questions.
Payroll, Invoices and Administrative Support
Experience with the following responsibilities is preferred but not required:
- Assisting with payroll preparation, timecard review, and payroll documentation.
- Reviewing and organizing vendor invoices.
- Tracking recurring practice expenses and payment due dates.
- Coordinating invoice approvals and maintaining payment records.
- Reconciling vendor statements and identifying billing discrepancies.
- Supporting basic financial reporting and administrative recordkeeping.
Compliance and Process Improvement
- Ensure billing, coding, authorization, and payment practices comply with federal, state, payer, and contractual requirements.
- Protect confidential patient and financial information.
- Maintain accurate provider, payer, patient, and credentialing records.
- Stay current with Medicare guidance, payer policy changes, coding updates, and system changes.
- Learn and adapt to new billing, practice-management, and workflow platforms as the organization evolves.
- Identify opportunities to reduce administrative work, improve collections, and prevent revenue leakage.
- Participate in billing and operational meetings as needed.
Qualifications
- Minimum of three years of medical billing, coding, or revenue cycle experience.
- Hands-on experience with Tebra or a comparable medical billing and practice-management platform.
- Ability and willingness to learn new software, workflows, payer portals, and technology systems.
- Experience independently processing a high daily volume of referrals and charges.
- Strong knowledge of insurance eligibility, benefits, referrals, prior authorizations, claims, payment posting, denials, appeals, and accounts receivable.
- Prior authorization experience involving medications, imaging, procedures, infusions, or specialty services.
- Knowledge of Medicare, commercial insurance plans, medical groups, and managed-care requirements.
- Neurology or specialty-practice experience is strongly preferred.
- CPC, CCS, CPB, or another recognized billing or coding certification is preferred.
- Credentialing and payer-enrollment experience is preferred.
- Payroll, invoice-management, bookkeeping, or practice financial-administration experience is a plus.
- Strong attention to detail and ability to manage multiple deadlines.
- Excellent written and verbal communication skills.
- Ability to communicate professionally with patients, providers, staff, referring offices, and insurance companies.
- Ability to work independently, follow tasks through to completion, and proactively identify problems.
Work Schedule and Compensation
- Full-time position based primarily at our Folsom clinic.
- Expected schedule is approximately 8:00 a.m. to 5:00 p.m., Monday through Friday.
- Limited hybrid flexibility may be considered after successful training and demonstration of consistent performance.
- Competitive hourly or salaried compensation based on experience, certification, and qualifications.
Why Join VerityMD?
- Join a growing and innovative physician-led neurology practice.
- Play an essential role in helping patients receive timely neurological care.
- Work directly with a collaborative team in a four-provider practice.
- Gain exposure to advanced neurology services, including infusion therapy, dementia care, Botox, EEG, EMG, autonomic testing, and PET imaging.
- Help create efficient systems that improve patient access, reduce denials, and strengthen the practice’s financial performance.
- Grow professionally as VerityMD expands its clinical programs and locations.
Job Type: Part-time
Pay: $22.00 - $30.00 per hour
Work Location: In person
