Senior Medical Billing & Coding Specialist

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

📋 Description

• Oversee daily U.S. medical billing and coding operations

• Prepare, assess, and submit claims to Medicare, Medicaid, and various commercial insurance providers

• Examine medical records and billing details to ensure accurate coding and claims submissions

• Apply and interpret CPT, ICD-10, HCPCS, and related modifiers

• Detect and rectify billing and coding mistakes that lead to claim rejections or denials

• Handle denials, rejected claims, appeals, and necessary claim adjustments

• Conduct Accounts Receivable follow-ups and resolve outstanding insurance balances

• Investigate unpaid, underpaid, and denied claims while coordinating with insurance companies

• Aid in the comprehensive Revenue Cycle Management process

• Analyze EOBs and ERAs, reconciling payments against submitted claims

• Execute payment postings and identify discrepancies

• Verify and maintain precise patient and insurance details

• Collaborate with payer portals, clearinghouses, EHR/EMR systems, and billing platforms

• Recognize recurring billing and denial challenges and suggest enhancements

• Maintain accurate records and documentation

• Communicate effectively with insurance companies, healthcare providers, patients, and internal teams

• Adhere to client-specific billing, coding, compliance, and workflow protocols

⛳️ Requirements

• At least 3 years of practical experience in U.S. medical billing and coding

• Direct experience within a U.S. healthcare practice, clinic, or healthcare organization

• Familiarity with healthcare specialties such as Primary Care, Behavioral Health, Mental Health, Dental, Ophthalmology, or Specialty Care

• Strong grasp of the U.S. healthcare Revenue Cycle Management process

• Hands-on experience in medical billing, coding, claims submission, denial management, Accounts Receivable, claim follow-up, payment posting, and insurance verification or eligibility

• Experience with Medicare, Medicaid, and commercial insurance

• Solid understanding of CPT codes and familiarity with ICD-10, HCPCS, and modifiers

• Capability to review claims and identify discrepancies in billing or coding

• Strong knowledge of insurance payer processes and requirements

• Proficient computer skills and ability to navigate healthcare software, EHRs/EMRs, clearinghouses, and payer portals

• Excellent written and verbal communication skills in English

• High attention to detail and accuracy

• Ability to work independently in a remote setting

• Direct practical experience in managing U.S. medical billing and coding processes

• Preferred: experience with complex denials, appeals, aging AR, multiple payer portals, clearinghouses, EHR/EMR, and practice management systems

• Certification in medical billing or coding is preferred but not mandatory

🏝️ Benefits

• Fully remote work arrangement

• Options for full-time and part-time work

• Flexible workload ranging from 15 to 40 hours per week, based on client needs