Medical Billing Specialist

Position Type: Full-Time | Remote

Working Hours: U.S. Business Hours

About the Role

We are looking for a detail-oriented Medical Billing Specialist to manage the end-to-end medical billing and claims process. In this role, you will be responsible for submitting accurate insurance claims, posting payments, investigating denials, and following up on outstanding accounts receivable.

You will work closely with the Finance team to ensure billing operations run smoothly, reimbursements are tracked accurately, and outstanding issues are resolved in a timely manner. The ideal candidate has hands-on experience with medical billing workflows, a solid understanding of insurance requirements, and the ability to work independently in a remote environment.

What You’ll Own

Claims Submission & Management

• Prepare, review, and submit medical claims to insurance payers.
• Verify claim accuracy and ensure all required coding and supporting documentation are included.
• Monitor claim status and address submission errors or rejections.

Payment Posting & Reconciliation

• Post insurance payments, adjustments, and patient payments to the appropriate accounts.
• Review Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERA) for payment accuracy.
• Identify and investigate discrepancies between expected and received reimbursements.

Denial Management & Appeals

• Investigate denied and rejected claims to identify underlying issues.
• Prepare and submit corrected claims or appeals within payer deadlines.
• Track denial trends and help prevent recurring billing errors.

Accounts Receivable Follow-Up

• Monitor outstanding claims and unpaid balances.
• Follow up with insurance companies regarding delayed or missing payments.
• Maintain accurate records of aging accounts and escalate unresolved issues when necessary.

Patient & Payer Communication

• Respond to billing-related inquiries from patients and insurance representatives.
• Resolve payment discrepancies and clarify claim-related questions.
• Maintain professional and timely communication with external payers and internal stakeholders.

Compliance & Documentation

• Follow applicable healthcare billing regulations, payer requirements, and internal procedures.
• Maintain accurate billing records and protect confidential patient information.
• Keep shared trackers and Finance team documentation updated.

Requirements

• Proven experience in medical billing, claims processing, or a similar healthcare finance role.
• Strong understanding of medical coding systems, including ICD-10, CPT, and HCPCS.
• Hands-on experience with insurance verification, EOBs, payment posting, and remittance processing.
• Experience using medical billing software or practice management systems.
• Understanding of the complete medical billing and claims lifecycle.
• Strong knowledge of insurance claim follow-ups, denial management, and appeals.
• Excellent attention to detail and strong organizational skills.
• Proficient written and spoken English, with the ability to communicate effectively with insurance payers and internal teams.
• Ability to work independently and manage multiple billing tasks in a remote environment.

Nice to Have

• Experience working with U.S. healthcare billing and insurance processes.
• Familiarity with common clearinghouses and electronic claims submission workflows.
• Experience managing accounts receivable aging reports and identifying reimbursement trends.
• Previous experience supporting a remote Finance or Revenue Cycle Management (RCM) team.

What Makes You a Strong Fit

• You identify billing discrepancies early and take ownership of resolving them.
• You are proactive with claim follow-ups and do not let outstanding items go unattended.
• You can manage repetitive, detail-heavy tasks while maintaining a high level of accuracy.
• You communicate clearly with internal teams and external insurance representatives.
• You understand the importance of patient data confidentiality and handle sensitive information responsibly.
• You are organized, self-motivated, and comfortable working with minimal supervision.

What Success Looks Like

• Medical claims are submitted accurately and within required timelines.
• Payments and adjustments are posted correctly, with discrepancies identified promptly.
• Denied claims are investigated and resolved through timely corrections or appeals.
• Outstanding accounts receivable are consistently monitored and followed up.
• Billing records and shared trackers remain accurate and up to date.
• The Finance team has clear visibility into billing progress, outstanding issues, and potential blockers.

Interview Process

• Initial application review.
• Client interview
• Final selection and offer.

Originally posted on Himalayas