Medical Billing Specialist

4 days ago

Manila, National Capital Region, Philippines Unlock HBA Full time $60,000 - $80,000 per year

This is a remote position.Virtual Rockstar is seeking a Medical Billing Specialist to support one of our pediatric therapy partners based in Nebraska.The Medical Billing Specialist will play a key role in ensuring accurate billing, efficient claims management, and effective authorization processes for the practice. This role requires strong attention to detail, knowledge of billing workflows, and the ability to track and analyze key performance indicators (KPIs) to support leadership decisions.You will work closely with the existing billing team and practice leadership to manage claims, resolve denials, and maintain compliance with payer requirements.About Our Client This therapy team's mission is empowering children, families, and the community through high-quality, family-centered services. Their culture emphasizes teamwork, accountability, and data-driven decision-making, with a strong focus on excellent patient outcomes and operational efficiency.ResponsibilitiesBilling & Claims ManagementProcess and submit claims to insurance providers. Follow up on unpaid claims and track resolution progress. Post payments to patient accounts and reconcile discrepancies. Review and appeal denied claims, ensuring accurate coding and documentation. Maintain compliance with billing regulations and payer requirements.Authorizations & Insurance ManagementVerify insurance coverage for patients. Obtain pre-authorizations for therapy services. Update patient files with authorization details. Track and manage authorizations to ensure timely renewals and service continuity. Communicate with payers to clarify coverage details and resolve issues.Reporting & KPIsRun aging reports weekly, highlighting high-dollar or >60-day claims for follow-up. Monitor denial management tracker and categorize denial reasons by payer. Compile and present monthly billing reports for leadership. Track and analyze KPIs related to billing efficiency, collections, and authorization turnaround times. Provide insights and trends to help improve systems and workflows.RequirementsProven experience as a Medical Biller, Billing Specialist, or similar role in a healthcare setting. Familiarity with pediatric or therapy-based billing preferred. Strong knowledge of insurance verification, authorization processes, and claims management. Experience with EMR and billing systems (practice uses Ensora Health, formerly Fusion). Proficiency in Microsoft Office 365, Excel, and Google Sheets for reporting. Excellent attention to detail, accuracy, and organizational skills. Strong communication skills for interacting with both internal teams and external payers. Ability to analyze data and present meaningful insights through KPI tracking.BenefitsCompetitive salary commensurate with experience. Opportunities for professional development and growth. Work in a dynamic and supportive team environment. Make a meaningful impact by helping to build and strengthen families in the Philippines. 

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