Senior Medical Billing & Coding Specialist

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

📋 Description

• Manage the daily operations of U.S. medical billing and coding tasks.

• Prepare, assess, and submit claims to Medicare, Medicaid, and private insurance companies.

• Evaluate medical records and billing details to ensure accurate coding and claims submission.

• Apply and interpret CPT, ICD-10, HCPCS codes, along with applicable modifiers.

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

• Handle denials, rejected claims, appeals, and corrections of claims.

• Conduct Accounts Receivable follow-up and address outstanding insurance balances.

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

• Assist in the overall Revenue Cycle Management process.

• Review EOBs and ERAs, reconciling payments with submitted claims.

• Carry out payment posting and identify any discrepancies.

• Verify and maintain precise patient and insurance information.

• Utilize payer portals, clearinghouses, EHR/EMR systems, and billing platforms.

• Recognize recurring billing and denial issues and suggest enhancements.

• Keep accurate records and documentation.

• Liaise 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.

• Practical 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 private insurance.

• Solid understanding of CPT codes along with working knowledge of ICD-10, HCPCS, and modifiers.

• Capability to identify discrepancies in billing or coding.

• Strong knowledge of insurance payer processes and requirements.

• Proficient computer skills with 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 autonomously in a remote setting.

• Certification is not mandatory; however, CPC, CCS, CPB, CCA, or equivalent certification is preferred.

• Specific working hours are contingent on client needs, with availability aligning with U.S. Eastern, Central, or Pacific Time zones.

🏝️ Benefits

• Fully remote work arrangement.

• Flexible workload ranging from 15–40 hours per week.

• Options for both full-time and part-time work.

• Independent contractor work setup.