Senior Medical Billing Specialist

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

📋 Description

• Consistently prepare and submit accurate claims across all service lines.

• Validate claims against clinical documentation within Ritten.io.

• Monitor clearinghouse reports for any rejections and errors; amend and resubmit claims as necessary.

• Ensure claims submission schedules are maintained to align with payer deadlines and internal billing cycles.

• Take ownership of denials, rejections, and unpaid claims through root-cause analysis and effective resubmission.

• Communicate with payers regarding authorizations, eligibility, coding, coordination of benefits, missing documentation, and system errors.

• Collaborate with the clearinghouse on transmission challenges, file format discrepancies, and claim routing issues.

• Document reasons for denials, corrective measures taken, and communications with payers.

• Analyze trends in denials and escalate systemic issues to the Revenue Cycle Manager.

• Cross-verify claims with clinical encounters and confirm the necessary data elements for CalAIM compliance.

• Bring attention to documentation gaps for the care team and Revenue Cycle Manager.

• Assist in the quality assurance reviews of clinical documentation and coding.

• Maintain billing logs, denial trackers, and accounts receivable aging reports.

• Support the month-end reconciliation process involving payments, adjustments, and unresolved claims.

• Generate reports on claim volumes, denial rates, payer trends, and days in accounts receivable.

• Enhance revenue cycle management workflows, standard operating procedures, and billing policies.

• Coordinate with Authorization Specialists, Care Managers, Supervisors, and Admissions to ensure compliance in billing.

• Participate actively in revenue cycle management meetings and training sessions.

⛳️ Requirements

• 3–5 years of experience in medical billing, claims follow-up, or payer resolution.

• Preferred experience with Medi-Cal/Medicaid.

• Familiarity with processing claims through clearinghouses, payers, and denial management systems.

• Strong knowledge of CPT/HCPCS codes, modifiers, ICD-10 codes, and Medicaid billing requirements.

• Experience in validating claims within an EHR system; prior experience with Ritten.io is highly preferred.

• Proficient in Excel/Google Sheets, including the use of filters, VLOOKUP, and pivot tables is preferred.

• Excellent written and verbal communication abilities.

• Capable of navigating payer conversations with professionalism.

• Highly organized and detail-oriented.

• Ability to manage multiple claims queues simultaneously.

• Availability to work across US time zones (EST–PST).

• Fluent or adequately proficient in English for professional communication.

• Willingness to complete a video interview within 24 hours if requested.

🏝️ Benefits

• Competitive salary.

• Opportunities for genuine growth.

• Long-term career potential.

• Option to work remotely.