Medical Billing Specialist – Claim Submission

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

📋 Description

• Take ownership of ensuring the accuracy of pre-submission billing and confirm that clean claims are submitted appropriately.

• Examine claims prior to submission to pinpoint issues related to coding, demographics, and documentation.

• Manage pre-submission billing edits and oversee claim scrubbing processes.

• Address coding-related challenges, including CPT modifiers, diagnosis inconsistencies, and authorization issues.

• Assess EHR data for accuracy concerning demographics, insurance details, rendering provider configuration, and payer stipulations.

• Detect and rectify any missing or incorrect patient, provider, or authorization information before claims are submitted.

• Collaborate with clinical, intake, credentialing, and operations teams to eliminate billing obstacles.

• Monitor clearinghouse rejections and ensure that corrections and resubmissions are handled promptly.

• Keep accurate billing records and maintain claim documentation.

• Facilitate communication with payers and clearinghouses through various channels such as portal, fax, phone, and email.

• Track recurring claim issues and proactively escalate systemic problems as needed.

⛳️ Requirements

• Bachelor's degree or equivalent professional experience.

• A minimum of 2–3 years of experience in healthcare billing or revenue cycle operations.

• Strong knowledge of medical billing processes, claim submission, and coding principles.

• Experience with EHR systems, clearinghouses, and billing software.

• Familiarity with both commercial and government insurance regulations.

• Proficient in MS Office and other business systems.

• Capable of managing multiple priorities and adhering to deadlines in a fast-paced environment.

🏝️ Benefits

• This position is remote.

• Opportunity to work outside of the United States while aligning with United States East Coast time zones.

• Engage in process improvement initiatives aimed at minimizing preventable denials and enhancing clean claim rates.