Senior Medical Billing Specialist – Primary Care

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

📋 Description

• Prepare, examine, submit, and monitor medical claims for various U.S. primary care providers.

• Utilize ICD-10, CPT, HCPCS, and E/M billing principles to identify billing inaccuracies and coding issues.

• Investigate claims that have been rejected, denied, pending, downcoded, or unpaid, and manage corrections, resubmissions, appeals, and follow-ups.

• Confirm patient insurance eligibility, coverage, and benefits.

• Supervise accounts receivable, outstanding balances, underpayments, denials, rejections, and payment discrepancies.

• Review clinical documentation for accuracy, completeness, and compliance in billing.

• Collaborate with providers and internal staff to address documentation inconsistencies.

• Directly manage, oversee, and support a team of medical billing associates.

• Assign and prioritize billing tasks while monitoring team performance.

• Provide coaching, guidance, and constructive feedback to team members.

• Develop and maintain standard operating procedures, training resources, and onboarding guides.

• Prepare daily progress reports, billing updates, backlog summaries, and follow-up strategies.

• Communicate billing issues, workflow obstacles, and reimbursement risks to management.

• Collaborate with providers, management, insurance representatives, and internal staff to enhance billing processes.

• Improve billing workflows, accuracy, compliance, and overall revenue cycle performance.

⛳️ Requirements

• Minimum of 3 years of documented, hands-on U.S. medical billing experience (mandatory).

• Significant experience in U.S. primary care medical billing (mandatory).

• Strong understanding of primary care diagnoses, medical billing workflows, and reimbursement procedures.

• Advanced knowledge of ICD-10, CPT, HCPCS, and E/M billing guidelines.

• Experience in preparing, reviewing, submitting, and tracking electronic medical claims.

• Comprehensive understanding of payer-specific billing requirements and timely filing deadlines.

• Hands-on experience with accounts receivable, denials, rejections, downcoding, insurance appeals, and payer follow-ups.

• Proven experience managing, supervising, or leading a team of medical billing associates (mandatory).

• Experience in creating, maintaining, and updating departmental standard operating procedures.

• Ability to develop training materials, onboarding resources, and processes for staff development.

• Strong understanding of clinical documentation requirements for primary care billing.

• Knowledge of compliance checks, risk mitigation, and escalation procedures related to billing.

• Solid understanding of HIPAA and patient confidentiality regulations.

• Proficiency in EHR/EMR systems, practice management software, and medical billing platforms.

• Experience using electronic claims submission systems, clearinghouses, and insurance portals.

• Strong skills with spreadsheets, claims trackers, billing reports, and productivity monitoring tools.

• Excellent written and verbal communication skills in English.

• Must be able to submit an NBI Clearance and/or Local Police Clearance prior to onboarding (mandatory).

• Must be available for video meetings with the camera on when necessary.

• Must be available for full-time work, Monday to Friday, from 9:00 AM to 6:00 PM Eastern Time.

• Reliable laptop or desktop computer is required.

• Stable high-speed internet connection with a minimum of 25 Mbps.

• Noise-canceling headset is needed.

• A working webcam is required.

• Quiet and professional work environment is essential.

🏝️ Benefits

• Dedicated HR & Contractor Support Team.

• Premium VPN Access (Optional).

• HIPAA & Cybersecurity Training + Certification (Provided).

• Top 1% VA Performance Training.

• Client-Approved U.S. Holidays.

• Client-Approved Paid or Unpaid Time Off (paid time off is optional and only if offered by the client).

• Access to Tools & Resources.

• Optional Performance-Based Incentives.

• Optional bonuses, incentives, or additional hours based on performance.