Medical Billing & Revenue Cycle Specialist

This is a fully remote position, open to applicants in Colombia, +5 more countries.

📋 Description

• Review and submit claims in Athena, ensuring both accuracy and completeness.

• Verify coding, modifiers, and payer requirements prior to submission.

• Monitor clearinghouse rejections, resolving and resubmitting affected claims.

• Track the status of claims throughout the billing cycle.

• Post insurance and patient payments based on ERA/EOB documentation.

• Reconcile payments against anticipated reimbursement and identify discrepancies.

• Apply adjustments, write-offs, and contractual allowances in line with guidelines.

• Identify, categorize, and manage denied or underpaid claims.

• Investigate denial root causes and implement corrective measures.

• Prepare and submit appeals with necessary supporting documentation.

• Monitor denial trends and escalate recurring issues as needed.

• Address patient billing inquiries via phone, email, and portal.

• Clarify EOBs, account balances, and billing policies to patients.

• Collaborate with practice and front-office teams to resolve account-related issues.

• Escalate complex account or clinical-adjacent matters for further review.

• Maintain daily tracking of billing outputs, which includes claim submissions and patient statements.

⛳️ Requirements

• A minimum of 3 years of direct U.S. medical billing and Revenue Cycle Management (RCM) experience, encompassing claims, payment posting, and denials.

• Hands-on experience with athenahealth (Athena) EHR/PM.

• Strong comprehension of the complete revenue cycle: charge entry, claims, ERA/EOB posting, denials, and appeals.

• Familiarity with EDI transactions, including 837 claims, 835 remittances, and 270/271 eligibility transactions.

• Knowledge of CPT, ICD-10, HCPCS, and payer-specific billing requirements for Medicare, Medicaid, and commercial payers.

• Proficient spoken and written English, with the ability to communicate directly and professionally with U.S. patients.

• Exceptional organization, attention to detail, follow-up, communication skills, and customer empathy.

• Reliable internet connection and a quiet workspace for remote work.

• Availability for full-time commitment as a primary and dedicated role.

• Preference for candidates with primary care billing experience.

• Strong preference for experience supporting multiple practices or accounts simultaneously.

• Previous BPO/offshore RCM experience supporting U.S. healthcare organizations is advantageous.

• Possession of CPB, CPC, or similar billing/coding credentials is a plus, though not mandatory.

• Availability from Monday to Friday, 9:00 AM–5:00 PM Eastern Time.

🏝️ Benefits

• Fully remote work environment.

• Stable, long-term collaboration.

• Clearly defined scope of responsibilities and structured workflows.

• Comprehensive training and onboarding support.

• Opportunity to collaborate with international teams.

• Exposure to modern tools and professional processes.

• Supportive and collaborative workplace culture.

• Opportunities for skill development and career advancement.

• Set work schedule established by the client.

• Training may be required.

• Performance evaluated through KPIs and goals.