Billing Specialist

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

📋 Description

• Manage daily denial queues in Candid and resolve claims via appeals or corrections.

• Prepare and submit appeals for denied claims, tracking them until resolution.

• Address pre-submission issues such as incorrect NPI setup, missing payer IDs, and gaps in provider enrollment.

• Correct claim information and resubmit claims to enhance the clean claim rate.

• Determine root causes of recurring denials and implement preventive measures.

• Process prior authorizations using the internal authorization dashboard, primarily for Medicaid plans.

• Monitor authorization status and follow up with payers until requests are either approved or denied.

• Communicate authorization decisions to providers and the scheduling team.

• Reach out to patients or families when additional details or documents are required for authorizations.

• Update KPI dashboards concerning days in A/R, claim turnaround time, and clean claim rate.

• Provide regular updates on backlog status and denial trends.

• Identify trends in denials and authorizations and propose process or system modifications.

• Report to the Head of RCM with minimal day-to-day supervision.

• Aim to reduce the existing backlog of 1,000–2,500 items and enhance A/R days, claim turnaround time, and clean claim rate.

⛳️ Requirements

• 2–5 years of experience in provider-side healthcare revenue cycle management at a practice, clinic, or outpatient provider; 3+ years preferred.

• Practical experience in denials management, including working denial queues, drafting appeals, and resubmitting corrected claims.

• Direct experience in prior authorization processes, including submitting requests, tracking status, and following up with payers.

• Familiarity with at least one clearinghouse or RCM platform, such as Candid Health, Waystar, Availity, Change Healthcare, Office Ally, or similar.

• Solid understanding of denial codes, NPI, payer IDs, and provider enrollment requirements.

• Proven track record of managing a denial or authorization queue with measurable outcomes.

• C2 English (CEFR) proficiency for phone interactions with patients, families, and insurance payers.

• Experience in Medicaid billing and prior authorization is preferred.

• Background in pediatric therapy billing is preferred.

• Knowledge of CPT coding and experience in reading EOB/ERA documents is preferred.

• Experience as a team lead, supervisor, or trainer in a billing or RCM team is preferred.

• Experience in a startup or high-growth healthcare practice is preferred.

🏝️ Benefits

• Competitive Salary: Based on experience and skills.

• Fully remote work from anywhere in the Philippines.

• Team incentives and recognition for maintaining 100% CRM hygiene and on-time reporting.

• Generous PTO in accordance with company policy.

• HMO coverage after 3 months for full-time employees based in the Philippines.

• Direct mentorship from international industry experts.

• Ongoing access to learning and development resources.

• Global networking opportunities.