Medical Billing

Job Title: Medical Billing & Coding Specialist (Primary Care)

Position Type: Full-Time

Work Hours: 9:00 AM to 6:00 PM Eastern Daylight Time

Work Days: Monday to Friday

Salary: $6 - $7 per hour, depending on experience

Workplace: Remote

Preferred Candidate Location: Philippines

Our client is a growing U.S.-based healthcare organization dedicated to providing high-quality, patient-centered care. We are seeking a reliable, detail-oriented, and experienced Medical Billing Specialist (Primary Care) to support accurate claims processing, timely reimbursement, and efficient revenue cycle operations.

In this role, you will take ownership of assigned medical billing responsibilities, including claims submission, insurance follow-ups, denial and rejection management, accounts receivable (AR), and billing-related documentation reviews. You will also help identify potential reimbursement risks, resolve outstanding claims, and maintain accurate reporting to support a smooth transition to an in-house billing process.

The ideal candidate has at least 1 year of hands-on U.S. medical billing experience, a solid understanding of medical coding concepts and payer requirements, and the ability to independently manage billing tasks with accuracy and accountability.

Experience in primary care and/or behavioral health billing is highly preferred.

If you are an organized, proactive medical billing professional who enjoys solving complex billing issues, improving reimbursement outcomes, and contributing to a growing healthcare team, we'd love to hear from you

Key Responsibilities

Medical Billing & Claims Management

• Prepare, review, submit, and track medical claims accurately and within payer filing deadlines.
• Apply knowledge of ICD-10, CPT, HCPCS, and Evaluation & Management (E/M) billing concepts to identify potential claim errors and documentation gaps.
• Investigate pending, rejected, denied, downcoded, or unpaid claims and determine appropriate next steps.
• Process claim corrections, resubmissions, reconsiderations, and appeals as needed.
• Follow up with insurance payers to resolve outstanding claims and reimbursement issues.
• Identify unfiled claims, approaching filing deadlines, and billing backlogs.
• Promptly escalation potential reimbursement risks or unresolved billing concerns.
• Maintain accurate records of submitted, pending, corrected, and resolved claims.

Insurance Verification & Revenue Cycle Management

• Verify patient insurance information, eligibility, and coverage when needed.
• Communicate with insurance representatives regarding claims, reimbursement, and coverage concerns.
• Manage assigned accounts receivable (AR) and follow up on outstanding balances.
• Investigate underpayments, payment discrepancies, and delayed reimbursements.
• Resolve payer denials, rejections, and downcoding issues through appropriate corrections and appeals.
• Assist with payment posting, reconciliation, and billing adjustments.
• Identify recurring billing issues and contribute to denial prevention efforts.
• Follow applicable payer policies, reimbursement guidelines, and billing requirements.

Clinical Documentation, Compliance & Risk Mitigation

• Review billing-related clinical documentation to ensure completeness and alignment with submitted claims.
• Identify missing, incomplete, or inconsistent documentation that may affect reimbursement.
• Coordinate with providers and internal staff to clarify documentation discrepancies.
• Verify that documentation supports billed services according to applicable payer requirements.
• Perform assigned documentation reviews, compliance checks, and risk mitigation tasks.
• Document findings accurately and escalation material compliance or reimbursement concerns.
• Stay informed of relevant payer requirements, billing policies, and regulatory updates.
• Maintain patient confidentiality and follow HIPAA requirements and organizational procedures.

Reporting, Accountability & Operational Support

• Maintain accurate daily progress reports detailing claims submitted, pending tasks, follow-ups, and unresolved issues.
• Verify claim submission status and supporting documentation before marking tasks as completed.
• Maintain transparent and accurate records of billing activities and outcomes.
• Collaborate with providers, internal staff, and billing colleagues to resolve issues.
• Identify opportunities to improve billing workflows, accuracy, and efficiency.
• Support the organization's transition to in-house medical billing operations.
• Assist with billing documentation, records management, and related administrative responsibilitie