US Medical Billing Specialist
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About the role
This is a specialized back-office revenue cycle support role focused on maximizing claim reimbursement through accurate insurance discovery, eligibility verification, and secondary payer claim follow-up. This is a non-patient-facing position ideal for candidates who excel at insurance research, portal navigation, payer outreach, and revenue cycle problem-solving using AdvancedMD software.
Key responsibilities
Perform proactive insurance discovery to identify active primary and secondary coverage for unbilled or demographic-rejected claims
Verify coverage dates, benefit caps, copays, deductibles, and authorization requirements using online payer portals, batch eligibility clearinghouses, and direct line inquiries
Update patient billing files and demographics in AdvancedMD to ensure clean claim submission on initial billing runs
Manage and process secondary insurance billing following primary adjudication (EOB/ERA review)
Contact commercial, Medicare, Medicaid, and supplemental insurance payers via telephone and web portals to resolve outstanding 2nd-party balances
Re-file claims with proper primary EOB attachments, coordination of benefits (COB) details, and appropriate billing modifiers
Identify and correct billing errors or payer rejections preventing secondary payment
Utilize AdvancedMD daily to work assigned aging reports, worklists, and claim hold queues efficiently
Document precise, professional accounts receivable notes regarding payer status, claim refilings, and expected resolution timelines
Collaborate with internal pathology coding and billing team members to resolve systemic billing blockers
About you
At least 1–3 years of US Medical Billing experience, revenue cycle management, or insurance claims processing (pathology or lab billing experience is a strong plus)
Minimum 1 year of hands-on experience using AdvancedMD (PM/RCM modules) preferred
Strong understanding of COB (Coordination of Benefits), primary vs. secondary payer rules, EOB interpretation, CPT/ICD-10 codes, and clearinghouse rejections
Proficiency with major insurance portals (Availity, NaviNet, Medicare/Medicaid portals) and web-based research tools
Exceptional attention to detail, strong analytical skills, and efficient phone etiquette when navigating insurance payer call trees
Maintain complete compliance with HIPAA rules and regulations, maintaining strict confidentiality over all Protected Health Information (PHI)
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