What Does a Medical Biller Do?
A medical biller plays a critical role in the healthcare revenue cycle by preparing, submitting, and tracking insurance claims to ensure timely and accurate reimbursement for medical services. Working closely with healthcare providers and coding professionals, medical billers translate clinical documentation into billable claims using standardized codes. They verify insurance coverage, enter patient charges into billing systems, and ensure compliance with payer rules and government regulations.
Beyond submitting claims, medical billers are responsible for following up on unpaid claims, resolving billing discrepancies, processing payments, and generating patient invoices when applicable. They also interpret Explanation of Benefits (EOBs), appeal denied claims, and maintain detailed records for audit and compliance purposes. Accuracy, attention to detail, and a solid understanding of insurance processes are essential to succeed in this fast-paced, high-stakes administrative role.
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Medical Biller Core Responsibilities
- Prepare and submit insurance claims based on coded medical records
- Verify patient insurance eligibility and benefits
- Review EOBs and remittance advice for payment accuracy
- Correct and resubmit denied or rejected claims
- Post payments and adjustments in billing software
- Generate patient invoices and manage account balances
- Respond to billing inquiries from patients and insurance companies
- Maintain billing records in compliance with HIPAA and regulatory standards
- Collaborate with medical coders and front office staff to resolve discrepancies
Required Skills and Qualifications
Hard skills
- Proficiency in medical billing software (e.g., Kareo, NextGen, Athenahealth)
- Understanding of insurance claim formats (CMS-1500, UB-04)
- Knowledge of ICD-10, CPT, and HCPCS codes
- Familiarity with payer guidelines and revenue cycle management
Soft skills
- Excellent attention to detail and problem-solving
- Strong written and verbal communication skills
- Ability to handle sensitive financial and health information with discretion
- Time management and multitasking in a deadline-driven environment
Education
- High school diploma or equivalent
- Completion of a medical billing or health administration program preferred
Certifications
- Preferred but not always required:
- Certified Professional Biller (CPB – AAPC)
- Certified Medical Reimbursement Specialist (CMRS – AMBA)
- Certified Billing and Coding Specialist (CBCS – NHA)
Preferred Qualifications
- 1–2 years of experience in medical billing, claims processing, or healthcare finance
- Familiarity with multiple payer systems including Medicare and Medicaid
- Experience in a specialty billing environment (e.g., orthopedics, dermatology, behavioral health)
National Average Salary
Medical biller salaries vary by experience, industry, organization size, and geography. Click below to explore salaries by local market.
The average national salary for a Medical Biller is:
$48,416
Sample Job Description Templates for Medical Billers
Entry-Level Medical Biller
Position Overview
We are seeking an Entry-Level Medical Biller to support our revenue cycle team by processing insurance claims and assisting with patient billing tasks. This is an excellent opportunity for a detail-oriented individual looking to begin a career in healthcare administration with hands-on training and room for growth.
Responsibilities
- Prepare and submit basic insurance claims using medical billing software
- Verify insurance eligibility and benefits for scheduled appointments
- Post payments and adjustments from EOBs and remittance advice
- Identify and escalate denied claims to senior billers for resolution
- Maintain accurate billing records in compliance with HIPAA guidelines
- Assist with patient billing inquiries and account updates
Requirements
Hard skills
- Basic knowledge of ICD-10, CPT, and HCPCS codes
- Familiarity with insurance billing forms and terminology
- Proficiency in Microsoft Office and/or EHR systems
Soft skills
- High attention to detail
- Willingness to learn and follow established workflows
- Good communication skills, especially in handling patient interactions
Education
- High school diploma or equivalent
- Completion of a medical billing program preferred
Certifications
- Not required
- Preferred: CBCS (NHA) or CPB (AAPC)
Preferred Qualifications
- Internship or practicum experience in a healthcare billing setting
Experienced Medical Biller
Position Overview
We are hiring an Experienced Medical Biller with a solid background in insurance claims processing, payment posting, and denial resolution. This role is responsible for ensuring timely reimbursement and supporting the financial operations of our medical practice.
Responsibilities
- Submit claims accurately for multiple payers including Medicare, Medicaid, and commercial insurers
- Follow up on unpaid or denied claims and submit appeals when necessary
- Review and reconcile EOBs, ensuring proper payment posting
- Communicate with patients regarding account balances and payment plans
- Maintain documentation and ensure compliance with HIPAA and billing regulations
Requirements
Hard skills
- Proficiency in medical billing software and EHR systems
- Knowledge of insurance payer guidelines and coding systems
- Familiarity with claims formats (CMS-1500, UB-04)
Soft skills
- Problem-solving and analytical thinking
- Strong written and verbal communication
- Ability to work independently and meet deadlines
Education
- High school diploma required; associate’s degree preferred
Certifications
- Preferred: CPB (AAPC), CBCS (NHA), or CMRS (AMBA)
Preferred Qualifications
- 2–3 years of medical billing experience in a healthcare setting
Senior Medical Billing Specialist
Position Overview
We are seeking a Senior Medical Billing Specialist to lead advanced claims processing, handle complex denials, and serve as a resource for junior billing staff. This role is essential to improving claim turnaround times and maximizing reimbursement.
Responsibilities
- Review complex claims and correct billing issues to reduce denials
- Monitor and analyze trends in claim rejections and implement corrective actions
- Serve as point of contact for high-priority accounts and escalated billing issues
- Assist in training junior billing staff and answering procedural questions
- Work with coders, providers, and insurance reps to resolve discrepancies
Requirements
Hard skills
- Advanced understanding of billing codes, modifiers, and payer policies
- Experience with high-volume claim processing and appeals
- Skilled in EHR and practice management systems
Soft skills
- Leadership and mentoring abilities
- Strong critical thinking and organizational skills
- Ability to manage priorities under pressure
Education
- Associate’s degree in health administration or related field preferred
Certifications
- Required: CPB (AAPC) or equivalent industry-recognized certification
Preferred Qualifications
- 4+ years of progressive billing experience, including complex specialties
Lead Medical Biller
Position Overview
We are hiring a Lead Medical Biller to oversee day-to-day billing operations, support training efforts, and assist with revenue cycle performance. This hands-on leadership role ensures compliance, accuracy, and billing team efficiency.
Responsibilities
- Oversee daily claim submissions and payer communications
- Provide guidance and support to billing team members
- Audit billing activity for accuracy and compliance
- Work cross-functionally with front office, coding, and finance departments
- Serve as liaison with payers for escalated claims or contract questions
- Develop and improve internal billing processes
Requirements
Hard skills
- Deep knowledge of CPT, ICD-10, and payer reimbursement practices
- Ability to use and train others on billing and practice management systems
- Experience with denial trends, appeals, and payer negotiations
Soft skills
- Leadership and team coordination
- Attention to detail and process improvement mindset
- Excellent communication and time management
Education
- Associate’s degree or equivalent experience
Certifications
- Required: CPB (AAPC), CMRS (AMBA), or equivalent certification
Preferred Qualifications
- 5+ years in medical billing with 1–2 years in a lead or supervisory role
Medical Billing Supervisor
Position Overview
We are seeking a Medical Billing Supervisor to lead our billing department, manage revenue cycle operations, and ensure high standards of billing accuracy, compliance, and reimbursement performance.
Responsibilities
- Supervise billing team and delegate tasks to meet department goals
- Monitor claim submission timelines, denial rates, and collection KPIs
- Conduct performance reviews and provide training and coaching
- Develop and enforce billing policies and compliance standards
- Collaborate with finance, clinical, and administrative leadership
- Report revenue cycle performance to executive team
Requirements
Hard skills
- Expertise in medical billing regulations, coding guidelines, and payer rules
- Proven experience with billing software and revenue cycle management tools
- Skilled in analyzing financial and operational data
Soft skills
- Leadership and team development skills
- Strategic planning and decision-making
- Clear communicator with conflict resolution abilities
Education
- Associate’s or bachelor’s degree in healthcare administration or related field
Certifications
- Required: CPB (AAPC), CMRS, or equivalent certification
- Recommended: BLS for office leadership roles
Preferred Qualifications
- 6+ years of medical billing experience with 2+ years in a supervisory role