Medical Billing Specialist - Practice Fusion

About this role

This is a remote position.

Job SummaryRCM Staff BPO is hiring a full-time Medical Billing Specialist to support a medical billing company based in Texas.The specialist owns the day-to-day billing cycle for one provider account: scrubbing and submitting claims, posting ERA and paper EOB payments, working denials and rejections, following up on outstanding claims, and preparing weekly and monthly billing reports for the client's management team. This role has no direct contact with the end practice, so all reporting and coordination goes through the client's management. This role requires solid end-to-end U.S. medical billing experience, strong attention to detail, consistent follow-up, and experience working with U.S. health insurance plans.

Key Responsibilities

• Scrub claims in the practice management system before submission and correct errors that would cause a rejection

• Submit clean claims to the clearinghouse, then correct and resubmit any claims that are rejected

• Post payments from ERAs and from scanned paper EOBs, attaching each scanned EOB to the patient ledger

• Work claim denials: identify the cause, then correct and resubmit or file an appeal

• For denials caused by incorrect insurance, check the Medicare website to identify the patient's Medicare Advantage plan

• Follow up on outstanding claims by checking payer websites, and call the insurance company directly when status is not available online

• Submit paper claims for patients with tertiary insurance

• Verify patient benefits when the client's management team passes along a verification request

• Contact the practice management system's support team for clearinghouse issues and payer ID lookups

• Run the weekly billed charges report and send it to the client's management team for reconciliation

• Compile the monthly accounts receivable (A/R) report and submit it to the client's management team before month end

• Provide claim and billing status updates to the client's management team so they can respond to the practice

• Protect patient information and follow HIPAA requirements

Qualifications

• At least 2 years of experience in U.S. medical billing or claims processing, including claim scrubbing and clearinghouse submission

• Experience posting payments from both ERAs and scanned paper EOBs

• Experience working claim denials and rejections, including corrected resubmissions and appeals

• Working knowledge of Medicare, Medicare Advantage, and coordination of benefits across primary, secondary, and tertiary insurance

• Familiarity with commercial insurance and government health plans

• Experience using payer portals and insurance websites, and comfortable calling payers by phone for claim status

• Able to reconcile two charge reports and identify variances

• Strong written and spoken English for internal reporting and coordination

• Excellent attention to detail and follow-up skills

• Ability to work independently and manage a full account with minimal supervision

• Reliable internet connection and a suitable remote workspace

Preferred Qualifications

• Experience using Practice Fusion EHR/PM

• Experience billing for a behavioral health or outpatient mental health practice

• Medical billing certification such as CPB or CMRS

• Experience working as a dedicated biller for a U.S. medical billing company or RCM vendor

• Familiarity with Texas insurance plans

Schedule

• Full-time position

• Must be available during Central Time business hours

• Final schedule will be determined based on practice needs

Work Arrangement

• Remote

• Philippines-based applicants preferred

Originally posted on Himalayas