Medical Billing Specialist

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

📋 Description

• Submit precise and timely insurance claims utilizing the practice’s EMR system and relevant clearinghouses.

• Assess claims for accuracy, completeness, and appropriate documentation prior to submission.

• Monitor outstanding claims and liaise with insurance companies concerning unpaid, delayed, or rejected claims.

• Investigate claim denials, determine causes, and execute corrections, resubmissions, or appeals.

• Verify claim status through payer portals, clearinghouses, and direct follow-ups with insurers.

• Accurately post insurance payments, electronic remittance advice, and adjustments.

• Reconcile payments and pinpoint underpayments, discrepancies, or missing reimbursements.

• Manage accounts receivable aging and prioritize claims that need immediate attention.

• Assist with provider enrollment, recredentialing, and insurance credentialing processes.

• Maintain systematic records of claims, denials, payments, follow-ups, and credentialing activities.

• Clearly communicate billing issues, trends, and unresolved matters to practice leadership.

• Provide regular updates on outstanding claims and actions undertaken.

• Safeguard patient and practice information in line with HIPAA regulations and internal policies.

• Acquire knowledge of and adhere to the practice’s established billing workflows and procedures.

⛳️ Requirements

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

• Strong grasp of the complete medical billing and revenue cycle process.

• Experience in submitting and managing insurance claims.

• Proven experience in resolving rejected and denied claims.

• Knowledge of insurance follow-up, appeals, payment posting, and accounts receivable.

• Familiarity with payer portals, clearinghouses, and electronic remittance systems.

• Proficient in platforms such as Availity, ECHO Health, Zelis, or similar systems.

• Experience managing CAQH ProView attestations, document uploads, and NPPES/NPI record updates.

• Skilled in navigating behavioral health payer portals including Optum/PayMyHealth (United Behavioral Health), Beacon/Carelon, Magellan, state Medicaid/MCO portals, and Availity.

• Familiarity with clearinghouses such as Change Healthcare, Waystar, TriZetto, and Office Ally.

• Working knowledge of provider credentialing and recredentialing processes.

• Understanding of HIPAA requirements and the confidentiality of patient information.

• Strong written and verbal communication skills in English.

• Excellent organizational, documentation, and follow-up abilities.

• Capability to work independently with minimal supervision.

• Strong problem-solving skills and meticulous attention to detail.

• Reliable internet connection along with a professional remote work setup.

🏝️ Benefits

• Health Insurance

• Flexible work arrangements