Medical Billing & Coding Specialist (Primary Care)

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 escalate 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 escalate 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 responsibilities.
• Communicate potential delays, unresolved concerns, and reimbursement risks promptly.

Top 3 Priorities

1. Accurate Claims Submission & Timely Filing

Ensure medical claims are complete, accurate, and submitted within payer deadlines. Proactively identify errors, documentation gaps, and unfiled claims to prevent avoidable denials, delayed payments, or lost reimbursement.

2. Accounts Receivable, Denial Resolution & Payer Compliance

Take ownership of assigned outstanding claims, denials, rejections, downcoding issues, and appeals. Maintain consistent insurance follow-ups while applying payer requirements and supporting accurate reimbursement.

3. Accountability, Communication & Risk Mitigation

Maintain accurate records of completed work, provide transparent progress updates, promptly flag billing and compliance concerns, and collaborate effectively with providers and the internal billing team.

What Success Looks Like

A successful Medical Billing Specialist consistently demonstrates:

• Accurate and timely claims submission.
• Strong follow-through on denied, rejected, downcoded, and unpaid claims.
• Effective management of assigned accounts receivable.
• Timely identification and escalation of filing deadlines, billing backlogs, and reimbursement risks.
• Accurate documentation reviews and adherence to payer requirements.
• Clear and transparent reporting of completed and outstanding work.
• Effective communication with providers, insurance representatives, and billing colleagues.
• Proactive identification of billing discrepancies and opportunities for improvement.
• Consistent compliance with HIPAA and billing-related policies.
• Reliable, independent performance while supporting the growth of the in-house billing team.

Requirements

• At least 1 year of proven, hands-on U.S. medical billing experience.
• Strong understanding of the U.S. medical billing and revenue cycle process.
• Experience preparing, reviewing, submitting, and tracking electronic medical claims.
• Working knowledge of ICD-10, CPT, HCPCS, and E/M billing concepts.
• Familiarity with payer reimbursement guidelines, billing requirements, and timely filing deadlines.
• Hands-on experience managing accounts receivable, unpaid claims, denials, rejections, downcoding, and appeals.
• Experience communicating directly with U.S. insurance payers regarding claim status and reimbursement issues.
• Ability to identify billing errors, documentation gaps, payment discrepancies, and unresolved claims.
• Experience performing claim corrections, resubmissions, and insurance follow-ups.
• Ability to review clinical documentation for billing completeness and payer-specific requirements.
• Strong attention to detail, analytical thinking, and problem-solving skills.
• Excellent organizational and time-management abilities.
• Ability to manage assigned tasks independently, meet deadlines, and maintain accurate records.
• Strong commitment to accuracy, accountability, and transparent reporting.
• Ability to collaborate professionally with providers, insurance representatives, and internal team members.
• Excellent written and verbal English communication skills.
• Demonstrated reliability, integrity, responsiveness, and willingness to escalate concerns promptly.

Clinical Documentation & Compliance Knowledge

• Understanding of medical documentation requirements related to claims submission and reimbursement.
• Ability to identify incomplete or inconsistent documentation.
• Familiarity with payer policies, billing compliance requirements, and relevant regulatory updates.
• Ability to coordinate with providers and internal staff regarding documentation concerns.
• Understanding of billing-related risk mitigation and appropriate escalation procedures.
• Knowledge of HIPAA requirements and patient confidentiality standards.

Technical & Administrative Skills

• Proficiency with EHR/EMR systems and practice management software.
• Experience using medical billing platforms and electronic claims submission tools.
• Comfortable working with spreadsheets, claims trackers, and billing reports.
• Ability to maintain accurate records of claims, payments, adjustments, and follow-ups.
• Strong documentation and administrative skills.
• Ability to prioritize outstanding claims and manage competing deadlines.
• Comfortable adapting to established workflows and new billing processes.

Preferred Qualifications

• Previous experience supporting U.S. primary care or behavioral health practices.
• Experience in family medicine, internal medicine, or multi-provider outpatient practices.
• Familiarity with primary care diagnoses, E/M guidelines, and outpatient documentation standards.
• Demonstrated success reducing claim denials or resolving downcoding issues.
• Experience managing accounts receivable backlogs and improving collections.
• Experience identifying billing workflow inefficiencies and recommending improvements.
• Previous experience supporting a U.S.-based healthcare organization remotely.
• Experience working with an internal or in-house medical billing team.

Ideal Candidate Profile

We're looking for someone who is:

• Experienced: Has a solid foundation in U.S. medical billing, coding concepts, and revenue cycle workflows.
• Detail-Oriented: Carefully reviews claims, documentation, and billing records to maintain accuracy.
• Proactive: Identifies unfiled claims, denials, downcoding issues, and documentation gaps before they become larger problems.
• Accountable: Maintains honest, accurate, and transparent records of completed work.
• Organized: Effectively manages multiple claims, follow-ups, and deadlines.
• Analytical: Investigates billing discrepancies and determines appropriate resolutions.
• Collaborative: Communicates effectively with providers and other billing team members.
• Independent: Takes ownership of assigned tasks without requiring constant supervision.
• Compliance-Focused: Prioritizes HIPAA, payer requirements, and risk mitigation.
• Adaptable: Comfortable supporting an organization transitioning to an in-house billing model.

Basic Requirements

• Must be proficient in speaking and writing clear, professional English.
• Must have at least 1 year of relevant U.S. medical billing experience.
• Must be able to submit an NBI Clearance and/or Local Police Clearance before onboarding (mandatory).
• Must be available for video meetings with camera on when required.
• Must be available to work full-time, Monday through Friday, from 9:00 AM to 6:00 PM Eastern Daylight Time.

Technical requirements

• Device: Reliable laptop or desktop computer.
• Internet: High-speed connection (minimum 25 Mbps).
• Audio: Noise-canceling headset.
• Video: Webcam for virtual meetings.
• Workspace: Quiet, professional environment.

Benefits

• Dedicated HR & Contractor Support Team: Access to world-class support for questions, guidance, contract matters, and client communication.
• Premium VPN Access (Optional): A secure VPN license can be provided upon request to enhance privacy and security for client-related tasks.
• HIPAA & Cybersecurity Training + Certification (Provided): Access to our internal HIPAA compliance training, cybersecurity modules, and certification to help you confidently handle PHI for U.S. healthcare clients.
• Top 1% VA Performance Training: Access to our proprietary training on communication, client management, productivity systems, and best practices to help you become a top-performing VA and increase long-term client retention.
• Client-Approved U.S. Holidays: Contractors may take U.S. holidays off according to the client’s needs and schedule.
• Client-Approved Paid or Unpaid Time Off: Time off may be granted by your client. Paid time off is optional and only if offered by the client.
• Access to Tools & Resources: Templates, workflow guides, productivity tools, and client-specific SOP support to help you perform at your best.
• Optional Performance-Based Incentives: Some clients may offer bonuses, incentives, or increased hours based on your performance.

These are optional resources and client-approved allowances available to you as an independent contractor. Any resources, trainings, or allowances listed are optional contractor perks and not employee benefits.

Originally posted on Himalayas