Medical Billing & Coding Team Lead – Physical Therapy

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

📋 Description

• Evaluate clinical documentation and precisely code outpatient physical therapy services in accordance with ICD-10 and relevant billing/coding standards.

• Ensure that coding is substantiated by documentation and adheres to payer and regulatory guidelines.

• Assess claims for accuracy and completeness prior to submission.

• Promptly submit accurate claims, prioritizing same-day submission when documentation is available.

• Identify any documentation or coding deficiencies and collaborate with clinicians for clarification.

• Oversee the billing cycle from claim preparation and submission to reimbursement and account resolution.

• Monitor outstanding claims and follow up with insurance carriers.

• Track reimbursements while identifying unpaid, underpaid, rejected, or incorrectly processed claims.

• Investigate and rectify billing discrepancies.

• Manage claim denials, corrections, reconsiderations, and appeals.

• Analyze denial trends and suggest process enhancements.

• Assist with payment posting and reconciliation processes.

• Follow up on outstanding patient and insurance balances while maintaining accurate account documentation.

• Keep billing trackers, follow-up queues, and aging reports updated.

• Verify insurance eligibility, benefits, coverage details, and authorization requirements.

• Obtain, track, and follow up on prior authorizations.

• Monitor expiration dates for authorizations and approved visit limits.

• Stay updated on Medicare and commercial payer requirements.

• Communicate with patients regarding benefits, billing inquiries, balances, and financial responsibilities.

• Collaborate with insurance companies, Medicare, referring providers, patients, physical therapists, and clinical staff.

• Document interactions with payers, claim statuses, authorization updates, appeals, and billing activities.

• Act as the primary contact for billing and coding operations.

• Prioritize billing tasks and ensure timely completion of urgent assignments.

• Promote team accountability and adhere to established workflows.

• Troubleshoot complex claims, payer issues, coding inquiries, and reimbursement challenges.

• Serve as the escalation point for challenging billing and operational issues.

• Work closely with Jonalyn and the current senior biller/office manager during the transition period.

• Gradually take on increased billing and operational responsibilities as the current lead reduces hours.

• Provide secondary office management and administrative support.

• Coordinate operational issues that impact billing, patient service, or clinical workflows.

• Facilitate communication between administrative, billing, and clinical teams.

• Assist with resolving operational problems through effective solutions.

• Engage in structured transition training and familiarize yourself with workflows.

⛳️ Requirements

• Significant hands-on experience in U.S. medical billing and coding is essential.

• Strong proficiency in ICD-10 coding and relevant medical billing codes.

• Comprehensive understanding of medical terminology and clinical documentation.

• Practical experience with insurance eligibility and benefits verification.

• Hands-on experience with prior authorization/pre-certification processes.

• Experience in medical coding and claim preparation.

• Proficient in electronic claim submission.

• Experience with claim status follow-up.

• Familiarity with payment posting and reimbursement tracking.

• Competence in denial management.

• Experience handling appeals and corrected claims.

• Background in outstanding balance and A/R follow-up.

• Solid understanding of Medicare guidelines and commercial payer requirements.

• Strong grasp of the healthcare revenue cycle.

• Experience engaging directly with insurance companies, patients, healthcare providers, and clinical teams.

• Ability to critically review documentation and identify information affecting coding or reimbursement.

• Experience working with EHR, practice management, and medical billing platforms.

• Excellent written and verbal communication skills in English.

• Strong organizational skills and time-management capabilities.

• Exceptional attention to detail and a commitment to billing accuracy.

• Ability to independently manage multiple priorities and deadlines in a remote environment.

• Demonstrated professionalism, maturity, reliability, accountability, and sound judgment.

• Capacity to take ownership of a vital revenue-cycle function with limited supervision.

• Must communicate and write in English clearly and professionally.

• Relevant work experience is a must.

• Must provide an NBI Clearance and/or Local Police Clearance prior to onboarding.

• Attendance at video meetings with camera on when required is necessary.

• A reliable laptop or desktop computer is essential.

• A stable high-speed internet connection of at least 25 Mbps is required.

• A noise-canceling headset is mandatory.

• A functioning webcam is needed.

• A quiet and professional work environment is essential.

🏝️ 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 (paid time off is optional and client-dependent).

• Access to Tools & Resources, including templates, workflow guides, productivity tools, and client-specific SOP support.

• Optional Performance-Based Incentives, bonuses, or increased hours based on performance.