Senior Medical Billing, RCM Specialist

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

📋 Description

• Oversee daily U.S. medical billing and revenue cycle operations.

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

• Review patient accounts, charges, medical records, and insurance details to ensure billing accuracy.

• Apply CPT, ICD-10-CM, HCPCS codes, and relevant modifiers.

• Detect and rectify billing and coding discrepancies leading to claim rejections or denials.

• Handle denied, rejected, unpaid, and underpaid claims efficiently.

• Conduct insurance follow-ups and liaise with payers regarding pending claims.

• Perform accounts receivable follow-ups, including aging AR management.

• Submit claim corrections, reconsiderations, and appeals as necessary.

• Review EOBs and ERAs, investigating any payment discrepancies.

• Execute or support payment posting and account reconciliation activities.

• Verify patient and insurance information diligently.

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

• Monitor outstanding accounts and take appropriate actions for resolution.

• Identify recurring billing, denial, and payment challenges, and communicate trends to the relevant team.

• Maintain precise billing documentation and adhere to client-specific procedures.

• Operate independently while fulfilling productivity, accuracy, and turnaround time expectations.

⛳️ Requirements

• A minimum of 3 years of practical U.S. medical billing experience.

• Experience working directly within a U.S. healthcare practice, clinic, medical organization, or a comparable healthcare environment.

• Strong comprehension of the U.S. healthcare revenue cycle.

• Direct experience with medical billing, claims submission, denial management, accounts receivable, insurance/payer follow-up, revenue cycle management, medical coding, CPT, ICD-10-CM, and HCPCS.

• Familiarity with U.S. insurance payers.

• Working knowledge of EHR/EMR systems, clearinghouses, payer portals, and/or medical billing software.

• Exceptional attention to detail and the capability to independently manage billing responsibilities.

• Strong written and verbal communication skills in English.

• Ability to thrive in a fully remote work setting.

• Experience in managing aging AR and complex denials is preferred.

• Background in handling appeals and claim reconsiderations is preferred.

• Knowledge of Medicare and Medicaid billing is preferred.

• Experience in payment posting and EOB/ERA reconciliation is preferred.

• Familiarity with multiple insurance payers and payer portals is preferred.

• Experience in Primary Care, Behavioral Health/Mental Health, Ophthalmology, Dental, Specialty Clinics, or other U.S. healthcare practices is preferred.

• CPC, CCS, CPB, CCA, or other relevant medical billing/coding certifications are preferred but not mandatory.

🏝️ Benefits

• Fully remote work arrangement.

• Options for full-time or part-time work.

• Work hours ranging from 15 to 40 hours per week.

• Schedule aligned with U.S. business hours and agreed availability.