Senior Medical Billing & RCM Specialist - Philippines

Job description

Employment Type: Independent Contractor | Full-Time & Part-Time Work Arrangement: Fully Remote Hours: 15–40 hours per week Schedule: U.S. business hours based on client requirements and agreed availability Time Zones: U.S. Eastern, Central, or Pacific Time About the Role We are seeking an experienced Senior Medical Billing & RCM Specialist with strong hands-on experience supporting U.S. healthcare practices and medical organizations . The ideal candidate will have a minimum of 3 years of direct U.S. medical billing experience and be comfortable independently managing key areas of the revenue cycle, including claims submission, denial management, accounts receivable (AR), insurance follow-up, payment/EOB review, and billing-related account resolution . This is a hands-on role for an experienced medical billing professional — not a general healthcare administrative or patient coordination position. Candidates with experience working directly within Primary Care, Behavioral Health/Mental Health, Ophthalmology, Dental, Specialty Clinics, or other U.S. healthcare practices are encouraged to apply. Key Responsibilities Manage day-to-day U.S. medical billing and revenue cycle activities. Prepare, review, and submit claims to Medicare, Medicaid, and commercial insurance payers . Review patient accounts, charges, medical records, and insurance information for billing accuracy. Apply knowledge of CPT, ICD-10-CM, HCPCS, and applicable modifiers as required. Identify and correct billing and coding issues that may result in claim rejections or denials. Manage denied, rejected, unpaid, and underpaid claims . Perform insurance follow-up and communicate with payers regarding outstanding claims. Conduct Accounts Receivable (AR) follow-up , including aging AR. Submit claim corrections, reconsiderations, and appeals as appropriate. Review EOBs and ERAs and investigate payment discrepancies. Perform or support payment posting and account reconciliation where required. Verify patient and insurance information as needed. Work with clearinghouses, payer portals, EHR/EMR systems, and billing platforms. Monitor outstanding accounts and take appropriate action toward resolution. Identify recurring billing, denial, and payment issues and communicate trends to the appropriate team. Maintain accurate billing documentation and follow client-specific procedures. Work independently in a remote environment while meeting productivity, accuracy, and turnaround-time expectations. Required Qualifications Minimum 3 years of hands-on U.S. medical billing experience. Experience working directly with a U.S. healthcare practice, clinic, medical organization, or similar healthcare setting . Strong understanding of the U.S. healthcare revenue cycle . Hands-on experience with: Medical Billing Claims Submission Denial Management Accounts Receivable (AR) Insurance/Payer Follow-up Revenue Cycle Management (RCM) Medical Coding CPT ICD-10-CM HCPCS Experience working with U.S. insurance payers. Working knowledge of EHR/EMR systems, clearinghouses, payer portals, and/or medical billing software . Strong attention to detail and ability to independently manage billing tasks. Strong written and verbal English communication skills . Ability to work effectively in a fully remote environment. Preferred Qualifications Experience managing aging AR and complex denials . Experience handling appeals and claim reconsiderations. Experience with Medicare and Medicaid billing. Experience with payment posting and EOB/ERA reconciliation. Experience with multiple insurance payers and payer portals. Experience in one or more of the following specialties: Primary Care Behavioral Health / Mental Health Ophthalmology Dental Specialty Clinics Other U.S. healthcare practices CPC, CCS, CPB, CCA, or other relevant medical billing/coding certification. Certification is preferred but not required. Strong practical U.S. medical billing experience is the priority. What We Are Looking For We are looking for an experienced medical billing professional who can work independently and take ownership of billing and revenue cycle tasks . Strong candidates should have practical experience across several stages of the U.S. revenue cycle, particularly: Claims Submission → Rejections/Denials → Payer Follow-up → AR → EOB/ERA Review → Payment Issues → Account Resolution Candidates whose experience is primarily limited to medical reception, scheduling, patient coordination, general healthcare administration, or data entry will not be the target profile for this position. Required Skills Medical Billing Revenue Cycle Management (RCM) Denial Management Accounts Receivable (AR) Claims Submission Insurance/Payer Follow-up Medical Coding CPT ICD-10-CM HCPCS EHR/EMR Desirable Skills Aging AR Payment Posting Appeals Medicare Medicaid EOB/ERA Billing Software Clearinghouses Payer Portals Healthcare Practice Experience