Medical Billing & RCM Specialist

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

📋 Description

• Oversee daily medical billing and Revenue Cycle Management (RCM) activities

• Prepare, submit, and monitor medical claims until payment is received

• Investigate and resolve issues related to claim denials, rejections, and unpaid claims

• Follow up with insurance companies regarding pending claims and reimbursements

• Conduct insurance eligibility and benefits verification

• Process and track prior authorizations while ensuring accurate documentation

• Collaborate extensively with Optum

• Maintain precise records of patients, billing, insurance, referrals, and authorizations

• Utilize Office Ally, insurance portals, clearinghouses, Square, spreadsheets, and shared drives

• Keep clear documentation of billing activities and any unresolved issues

• Communicate in a professional manner with insurance representatives, patients, and healthcare offices

• Adhere to established SOPs and workflows while ensuring HIPAA compliance

⛳️ Requirements

• U.S. healthcare experience is mandatory

• Medical Billing and RCM experience is essential

• Experience managing claims from submission to payment is required

• Proven ability to resolve denials, rejections, and unpaid claims

• Insurance verification and prior authorization experience is necessary

• Familiarity with healthcare billing, EHR, or practice management systems is needed

• Proficiency with Office Ally is highly preferred

• Experience with Optum is a significant advantage

• Knowledge of insurance portals and clearinghouses is important

• Strong grasp of U.S. medical billing and insurance workflows is required

• Previous remote/VA experience is preferred but not mandatory

• A medical degree or clinical license is not required

• Exceptional attention to detail, organization, and problem-solving abilities are essential

• Capability to manage multiple claims, follow-ups, and deadlines

• Strong written and verbal communication skills in English are necessary

• Professional phone communication abilities are required

• Ability to work independently while following detailed SOPs is crucial

• Knowledge of HIPAA compliance is necessary; certification is preferred

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

• Availability for video meetings with the camera on when required is essential

• Reliable laptop or desktop computer is needed

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

• Noise-canceling headset is necessary

• A working webcam is essential

• A quiet and professional work environment is required

🏝️ Benefits

• Dedicated HR & Contractor Support Team

• Premium VPN Access (Optional)

• 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

• Independent contractor perks and client-approved allowances