Job Description

Qualifications: Education, Licensure and Certifications, Related Work Experience

· High school diploma or equivalent.

· Minimum 2 years of medical billing experience, preferably in a multi‑specialty or large physician practice setting.

· Certification as a Certified Professional Biller (CPB) or similar credential is preferred.

Other specialized skills and knowledge necessary to perform this job. (e.g., basic accounting principles, computer skills and software, specific healthcare processes, interpersonal, communication, etc.

1.

Strong understanding of CPT, ICD‑10, and HCPCS coding principles.

3.

Proficiency with EMR and practice management system

2.

Familiarity with Medicare, Medicaid, and major commercial insurance plans

4.

Strong attention to detail and ability to manage multiple tasks in a high‑volume environment

Essential Job Duties/Responsibilities

1.

Prepare and share clean claims with outsourced billing company for submission to insurance carriers, government programs, and third‑party payers per payer guidelines

2.

Review charges for accuracy, completeness, and compliance with CPT, HCPCS, and ICD‑10 coding standards

3.

Resolve claim edits, denials, and rejections by researching payer requirements and correcting billing errors

4.

Conduct timely follow‑up on unpaid or underpaid claims to ensure optimal reimbursement

5.

Process adjustments, refunds, and billing corrections as needed

6.

Respond to patient billing inquiries professionally and with strong customer service

7.

Monitor aging reports and maintain accounts receivable within departmental benchmarks

8.

Collaborate with coding specialists and clinical teams to clarify documentation or coding discrepancies

9.

Maintain knowledge of payer policies, contract terms, and regulatory billing guidelines

10.

Support month‑end close processes and assist with revenue cycle projects as assigned

11.

Other related duties as assigned.

Compliance Requirements

Adherence to Laws, Rules, Regulations, Standards, Guidelines, Policies and Procedures:

· Ensure compliance with all federal, state, and local laws, regulations, standards, guidelines, and Eventus WholeHealth policies and procedures pertaining to the job.

· Remain informed of any changes to federal, state, and local laws, regulations, standards,guidelines, and Eventus WholeHealth policies and procedures that impact the job and the company.

· Promptly report any non-compliant conduct and/or practices to Eventus WholeHealth’s Chief Compliance and Risk Officer.

Ethical Conduct:

· Ensure adherence to Eventus WholeHealth's Code of Ethics and Business Conduct.

· Perform the job duties with integrity and professionalism.

· Promptly report any unethical conduct and/or practices to Eventus WholeHealth’s Chief Compliance and Risk Officer.

Patient Privacy and Confidentiality:

· Strictly protect patient information in accordance with all federal and state privacy laws and Eventus WholeHealth policies and procedures.

· Promptly report any violations of federal and state privacy laws and Eventus WholeHealth

· policies and procedures to Eventus WholeHealth’s Chief Compliance and Risk Officer.

Documentation and Record Keeping:

· Maintain accurate and complete documentation when performing the job duties.

· Ensure that all Eventus WholeHealth information, data, documentation, and records are always safeguarded and maintained confidentially.

Training and Education:

· Participate in all assigned training.

· Complete all assigned training by the deadline for completion.

Risk Management and Incident Reporting:

· Engage in regular risk assessments to identify potential risks and work proactively with a supervisor and Eventus WholeHealth’s Chief Compliance and Risk Officer to mitigate any identified risks.

· Promptly report any incidents (as defined in the “Incident Report Policy”) to the Chief Compliance and Risk Officer.