Medical Billing & Claims Specialist

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

📋 Description

• Accurately and efficiently post and process medical claims.

• Oversee claims for medical procedures from submission to resolution.

• Review claims to ensure completeness and accuracy prior to processing.

• Maintain precise posting and billing records.

• Handle a consistent daily workload of claims, ensuring quality and accuracy.

• Monitor claim status and follow up on pending claims.

• Ensure claims are processed in accordance with established billing and compliance standards.

• Address and resolve denied or rejected claims.

• Identify reasons for denials and implement corrective measures.

• Resubmit or follow up on claims as needed.

• Strive for successful claim overturns and reimbursement.

• Accurately document denial actions and follow-up on claims.

• Recognize recurring billing or denial challenges.

• Provide billing assistance to the current in-house billing team.

• Support complex billing situations, including multiple patient reimbursements.

• Review payer information and billing documentation.

• Keep organized and accurate billing records.

• Adhere to compliance and confidentiality protocols.

• Assist with additional billing-related tasks as assigned.

• Aim for at least 80 claims posted daily, with approximately 85–90% successful resolution/payment of processed claims.

⛳️ Requirements

• A minimum of 2–3 years of experience in medical billing.

• Required hands-on experience with claims posting.

• Strong experience managing claims for medical procedures is essential.

• Experience in resolving denied and rejected claims is necessary.

• Comprehensive understanding of the medical billing and claims lifecycle.

• Ability to investigate claim issues and determine appropriate subsequent actions.

• Experience in handling complex billing scenarios.

• Strong grasp of billing accuracy, compliance, and confidentiality regulations.

• Capability to manage a high volume of claims while ensuring accuracy.

• Excellent attention to detail and organizational capabilities.

• Ability to work independently and consistently meet productivity goals.

• Proficient in clear and professional written and spoken English.

• Reliable, accountable, and comfortable working within an established billing team.

• Must provide relevant work experience.

• Must be able to present an NBI Clearance and/or Local Police Clearance before onboarding (mandatory).

• Availability to attend video meetings with camera on when required.

• Possession of a reliable laptop or desktop computer.

• Stable high-speed internet connection (minimum 25 Mbps).

• Noise-canceling headset.

• Working webcam for virtual meetings.

• Quiet and professional work environment.

🏝️ Benefits

• Dedicated HR & Contractor Support Team.

• Optional Premium VPN Access.

• HIPAA & Cybersecurity Training + Certification (Provided).

• Top 1% VA Performance Training.

• Client-Approved U.S. Holidays.

• Client-Approved Paid or Unpaid Time Off.

• Access to Tools & Resources.

• Optional Performance-Based Incentives.

• Potential bonuses, incentives, or increased hours based on performance.