Medical Biller I
Exagen Inc.
Summary
Under the direction of the Billing Team Lead, the Medical Biller is responsible for managing claims from submission to adjudication. The biller will also process appeals and grievances, conduct pertinent research to evaluate, respond to and close appeals while building case files for each grievance, and ensure compliance with organizational and regulatory guidelines.
Job description
Overview
Under the direction of the Billing Team Lead, the Medical Biller is responsible for managing claims from submission to adjudication. The biller will also process appeals and grievances, conduct pertinent research to evaluate, respond to and close appeals while building case files for each grievance, and ensure compliance with organizational and regulatory guidelines.
Qualified candidates will have extensive knowledge of medical and third-party billing procedures, policies and concepts, a thorough understanding of Federal and State health programs, PPO, HMO, and Indemnity Plans.
Responsibilities
- Review and reconcile accounts, identifying and resolving discrepancies.
- Collaborate with internal teams to obtain necessary documentation and information for billing purposes.
- Manages submission, intervention, and resolution of appeals, grievances, and/or complaints.
- Conducts pertinent research, evaluates, responds and completes appeals and other inquiries accurately, timely and in accordance with all established regulatory guidelines.
- Prepares appeals summaries and correspondence and documents information for tracking/trending data.
- Assists with processing incoming and outgoing correspondence.
- Assists with the request and processing of patient medical record.
- Assures timeliness and appropriateness of all Provider appeals according to federal and state guidelines.
- Maintain accurate and organized billing records and documentation.
- Other duties as assigned.
Qualifications
- Minimum of 2 years' experience, preferably in a laboratory billing environment.
- Strong understanding of insurance billing, including Medicare, Medicaid and commercial insurance plans.
- Able to identify payer and denial trends and provide solutions for process improvements and enhancements.
- Excellent analytical skills.
- Working knowledge of appropriate coding systems; CPT, ICD-10 and HCPCS, coverage; LCD/NCD and reimbursement associated with such codes.
- Effective problem-solving skills in a fast paced and rapidly changing environment.
- Excellent verbal and written communication skills.
- Must be proficient in Microsoft Excel.
- Quadax experience strongly desired.
Requirements
- Minimum of 2 years' experience, preferably in a laboratory billing environment
- Strong understanding of insurance billing, including Medicare, Medicaid and commercial insurance plans
- Able to identify payer and denial trends and provide solutions for process improvements and enhancements
- Excellent analytical skills
- Working knowledge of coding systems: CPT, ICD-10 and HCPCS, coverage; LCD/NCD and reimbursement associated with such codes
- Effective problem-solving skills in a fast paced and rapidly changing environment
- Excellent verbal and written communication skills
- Must be proficient in Microsoft Excel
- Quadax experience strongly desired
Benefits
- Medical, Dental & Vision
- Health Care FSA
- Dependent Care FSA
- 401(k) Retirement Savings
- 4 Weeks PTO
- Paid Company Holidays
- Employer-Paid Life Insurance
- Optional Life Insurance
- Short-Term Disability
- Long-Term Disability
Company overview
Exagen Inc. is a patient-focused, discovery-driven commercial-stage life sciences company specializing in autoimmune disease diagnostics. Founded in 2002 and headquartered in Vista, California, the company operates as a CLIA-certified, CAP-accredited laboratory with a comprehensive menu of proprietary tests focused on rheumatology and autoimmune diseases. Exagen's flagship AVISE testing platform provides advanced diagnostic solutions for conditions such as lupus, rheumatoid arthritis, and other connective tissue diseases. The company's innovative biomarker technologies, including anti-PAD4 antibodies and CB-CAPs, enable more accurate and efficient diagnosis, particularly for seronegative cases that traditional tests often miss. Exagen's commitment to personalized medicine extends to therapeutic drug monitoring for medications like hydroxychloroquine and methotrexate, helping physicians optimize treatment regimens. With a strong research and development focus, the company collaborates with academic institutions and biopharmaceutical partners to advance autoimmune disease understanding and develop novel diagnostic approaches. Exagen serves healthcare providers across the United States, offering both diagnostic and prognostic testing solutions that enhance clinical decision-making and improve patient outcomes in autoimmune care.