Billing, Accounts Receivable Specialist

This is a fully remote position, open to applicants in Philippines.

📋 Description

• Analyze assigned accounts receivable work queues, aging reports, and outstanding claims.

• Engage with insurance payers via payer portals, phone calls, electronic inquiries, and written communication.

• Investigate unpaid, underpaid, rejected, and denied claims to determine suitable resolutions.

• Rectify billing errors and submit corrected claims, reconsiderations, and appeals within payer filing deadlines.

• Review remittance advice, explanations of benefits, and electronic remittance data.

• Identify payment discrepancies, contractual underpayments, inappropriate denials, and incorrect patient responsibility.

• Confirm claim receipt, processing status, payment details, denial reasons, and documentation requirements.

• Research eligibility, benefits, authorizations, referrals, coordination of benefits, credentialing, enrollment, coding, and claim-routing issues.

• Verify accurate patient, provider, payer, diagnosis, procedure, modifier, place-of-service, and billing information.

• Submit requested medical records and supporting documentation to payers.

• Transfer balances to the appropriate payer or patient following necessary research.

• Address credit balances and payment-posting discrepancies.

• Maintain thorough account notes and track deadlines.

• Follow up until all assigned claims or balances are fully resolved.

• Escalate recurring payer issues, system problems, credentialing concerns, coding inquiries, and high-dollar accounts.

• Communicate professionally with clients, providers, patients, payers, and internal team members.

• Meet expectations for productivity, quality, accuracy, and turnaround time.

• Participate in account reviews, team meetings, training sessions, and process-improvement initiatives.

• Uphold confidentiality and comply with HIPAA, company policies, payer requirements, and healthcare regulations.

• Perform additional billing and revenue-cycle responsibilities as assigned.

⛳️ Requirements

• High school diploma or equivalent is required.

• A minimum of two years of experience in medical billing, insurance follow-up, or healthcare accounts receivable is required/preferred.

• Strong background in billing for general outpatient specialties, including Primary Care, Psychiatry, Gastroenterology, and Dermatology.

• Experience with practice management systems, electronic health records (EHRs), clearinghouses, and payer portals.

• Familiarity with platforms such as Tebra, SimplePractice, Practice Fusion, Athena, eClinicalWorks, etc.

• Working knowledge of the medical billing and revenue-cycle processes.

• Experience in researching claim status and resolving rejections, denials, and underpayments.

• Ability to interpret remittance advice, explanation of benefits (EOB), denial codes, adjustment reason codes, and payer correspondence.

• Familiarity with CPT, HCPCS, ICD-10-CM codes, modifiers, and medical terminology.

• Strong written and verbal communication abilities.

• Excellent organizational, problem-solving, and analytical skills.

• Capability to manage multiple priorities and oversee accounts through to final resolution.

• Proficiency with Microsoft Office, including Excel, Outlook, and Word.

• Must successfully complete a 90-day probation period.

• Preferred: Experience with Medicare, Medicaid, commercial insurance, managed-care plans, and workers’ compensation.

• Preferred: Experience in preparing corrected claims, reconsiderations, and formal payer appeals.

• Preferred: Knowledge of payer contracts, reimbursement methodologies, and contractual adjustments.

• Preferred: Certified Professional Biller (CPB), Certified Professional Coder (CPC), or another relevant healthcare certification.

• Preferred: Experience in a multi-specialty or outsourced revenue-cycle environment.

🏝️ Benefits

• Remote position.

• Equal opportunity through inclusive hiring practices.

• Continuous learning programs.

• Regular equity assessments.

• Participation in team training sessions and process-improvement initiatives.