Medical Biller – Full Cycle Revenue Cycle Management, Internal Medicine, Pediatrics

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

📋 Description

• Oversee the entire revenue cycle for a practice specializing in Internal Medicine and Pediatrics, including subspecialties in Obesity Medicine and Nutrition.

• Assess charges and claims for billing precision while verifying CPT, HCPCS, and ICD-10 coding accuracy.

• Submit accurate electronic claims, track clearinghouse statuses, and rectify and resend any claims that have been rejected.

• Accurately post insurance EOBs/ERAs and patient payments, ensuring daily reconciliation of posting logs.

• Investigate denial codes, address underlying issues, resubmit claims, and compile appeal packages with appropriate clinical documentation.

• Monitor appeals until resolution and suggest workflow improvements based on recurring denial trends.

• Review aging reports for outstanding or underpaid claims and engage with payers to resolve any outstanding balances.

• Oversee patient statements, payment plans, collection inquiries, and ensure resolution documentation is maintained in the EMR.

• Confirm insurance eligibility, deductibles, copays, coinsurance, network participation, and coordination of benefits.

• Identify services, procedures, and medications that necessitate prior authorization and submit relevant documentation.

• Track authorization requests, keep track of expiration dates, and manage escalations related to authorization appeals.

• Monitor electronic faxes for payer decisions, authorization approvals, and claims correspondence; route and archive documents in eClinicalWorks.

• Manage incoming and outgoing billing calls with both payers and patients utilizing the Telzio VOIP system.

⛳️ Requirements

• A minimum of 3+ years of comprehensive, hands-on experience in U.S. medical billing and revenue cycle management.

• Significant experience in claim submissions, accounts receivable follow-up, payment posting, complex denial and appeals processes, patient collections, and eligibility/prior authorizations.

• Strong knowledge of standard CPT, HCPCS, and ICD-10 coding, including modifier application.

• Excellent written and verbal communication skills in English; comfortable engaging with insurance representatives and patients.

• In-depth understanding of HIPAA regulations, patient privacy considerations, and medical records management.

• Recent practical experience with eClinicalWorks (eCW), requiring minimal additional system-specific training.

• Billing expertise in Internal Medicine, Pediatrics, or specialized practices in Obesity Medicine, Weight Management, or Nutrition.

• Proven track record of obtaining approvals and managing denials for medications related to weight management and chronic diseases.

• Familiarity with Telzio VOIP or other similar softphone applications, as well as digital fax management processes.

🏝️ Benefits

• Competitive salary with opportunities for professional development.

• Comprehensive health, dental, and vision insurance plans.

• Flexible working hours and remote work options.

• Retirement savings plan with employer matching contributions.

• Supportive and collaborative team environment with a focus on work-life balance.