Job Description

We are looking for a highly detailed, collaborative, and Bilingual Medical Biller & Eligibility Specialist to join a growing billing department. This role bridges the gap between front-end operations and back-end revenue cycle management, ensuring administrative accuracy before the patient even sees the provider.

You must possess a deep understanding of U.S. medical insurance workflows, eligibility functions, and specific payer rules. Operating as a core liaison, you will work closely with our front desk and communications teams to secure clean claims, prevent denials, and provide a seamless onboarding experience for our patients.

Key Responsibilities:

Insurance Verification & Eligibility Support

• Real-Time Verifications: Execute comprehensive insurance eligibility and benefit verifications for upcoming orthopedic appointments across major commercial, government (Medicare/Medicaid), and workers' compensation payers.
• Front-End Collaboration: Assist the front desk and communications departments with front-end insurance processes, helping to troubleshoot active/inactive coverage issues prior to patient check-in.
• Patient Cost Estimation: Identify deductibles, copays, and co-insurance requirements, accurately updating records so the front-desk team can collect correct point-of-service payments.

Referral & Prior Authorization Management

• Referral Acquisition: Proactively track, request, and obtain required insurance referrals from primary care physicians (PCPs) and insurance portals.
• Payer Rules Adherence: Stay up-to-date on shifting payer requirements to ensure all orthopedic imaging, injections, or specialist visits meet strict medical necessity guidelines.
• Data Integration: Document and meticulously attach verified referrals and authorization codes within the ModMed EMR system to guarantee smooth billing continuity.

Bilingual Patient & Internal Communications

• Language Support: Utilize fluent English and Spanish to assist the billing and communications teams when addressing complex insurance questions from patients.
• Workflow Continuity: Document patient communication notes clearly within the system to maintain transparency across clinical and financial departments.

Requirements

• Experience: Minimum 2–3+ years of dedicated U.S. healthcare experience specializing in insurance verification, referrals, or medical billing.
• Linguistic Fluency: Native or professional bilingual fluency in both English and Spanish (written and verbal).
• Workflow Competency: Thorough, foundational knowledge of U.S. insurance structures, coordination of benefits (COB), and orthopedic billing workflows.
• Technical Setup: Secure home office infrastructure with high-speed internet, a secondary monitor (preferred), and a noise-canceling headset.
  
  Preferred Qualifications:
• EMR Mastery: Hands-on, administrative experience utilizing Modernizing Medicine (ModMed / EMA) software.
• Specialty Knowledge: Prior experience working specifically within an Orthopaedics, Physical Therapy, or Sports Medicine outpatient clinic.