Senior Medical Billing Specialist (Primary Care)

About this role

Job Title: Senior Medical Billing Specialist (Primary Care)
Position type: Full-Time
Work hours: 9:00 AM to 6:00 PM Eastern Time
Work days: Monday to Friday
Salary: $7 - $8 per hour
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 highly experienced, detail-oriented, and results-driven Senior Medical Billing Specialist (Primary Care) to oversee medical billing operations, ensure accurate reimbursement, and lead a team of medical billing associates.
This role combines advanced U.S. primary care medical billing expertise with hands-on team leadership, revenue cycle management, compliance oversight, and process improvement. You will be responsible for ensuring claims are submitted accurately and on time, resolving complex reimbursement issues, maintaining billing procedures, and supporting the professional development of billing associates.
The ideal candidate has at least 3 years of hands-on U.S. medical billing experience, extensive primary care billing knowledge, and proven experience managing or supervising a medical billing team.
You should be confident navigating complex billing processes, applying medical coding knowledge, monitoring payer requirements, and implementing systems that promote accuracy, accountability, and efficiency.
If you're an experienced medical billing professional who enjoys solving complex billing challenges, mentoring team members, and improving revenue cycle performance, we'd love to hear from you!
Key Responsibilities
Primary Care Medical Billing & Claims Management

• Prepare, review, submit, and track medical claims for multiple U.S. primary care providers accurately and within payer filing deadlines.

• Apply advanced knowledge of ICD-10, CPT, HCPCS, and Evaluation & Management (E/M) billing concepts to identify billing errors, coding discrepancies, and documentation gaps.

• Review claims for accuracy, completeness, and compliance with payer-specific requirements.

• Investigate rejected, denied, pending, downcoded, or unpaid claims and oversee corrections, resubmissions, appeals, and follow-ups.

• Identify missed or unfiled claims, aging accounts, and outstanding billing backlogs.

• Prioritize time-sensitive claims and promptly escalate potential reimbursement risks.

• Maintain accurate records of submitted, pending, corrected, and resolved claims.

• Support consistent, timely reimbursement through proactive claims management and follow-up.

Insurance & Revenue Cycle Management

• Verify patient insurance eligibility, coverage, and benefits when needed.

• Communicate with insurance representatives regarding claim status, reimbursement, and payer requirements.

• Oversee accounts receivable (AR), outstanding balances, underpayments, denials, rejections, and payment discrepancies.

• Investigate and resolve downcoding issues, delayed reimbursements, and other revenue cycle concerns.

• Guide payment posting, reconciliation, billing adjustments, and insurance follow-up processes.

• Monitor reimbursement turnaround times and identify opportunities to reduce aging claims.

• Implement process improvements to minimize avoidable denials, reimbursement delays, and revenue loss.

• Stay informed of relevant payer rules, reimbursement guidelines, billing regulations, and policy updates.

• Communicate important payer changes to the billing team and incorporate them into established workflows.

Clinical Documentation, Compliance & Risk Mitigation

• Review billing-related clinical documentation to ensure it supports submitted diagnoses, procedures, and services.

• Identify missing, incomplete, inconsistent, or insufficient documentation that could affect claim accuracy or reimbursement.

• Coordinate with providers and internal staff to resolve documentation discrepancies before claim submission.

• Ensure billing and documentation workflows align with applicable payer requirements and organizational policies.

• Monitor payer policy changes, documentation standards, and relevant regulatory updates.

• Conduct regular documentation reviews, compliance checks, and billing quality assessments.

• Identify potential compliance concerns, document findings, and promptly escalate material risks.

• Promote consistent adherence to HIPAA requirements and patient confidentiality standards.

Billing Team Leadership, Training & SOP Management

• Directly manage, supervise, and support a team of medical billing associates.

• Assign and prioritize billing responsibilities to maintain productivity and timely claims processing.

• Monitor individual and team performance, work quality, and task completion.

• Review actual claim submission statuses, work queues, documentation, and outstanding follow-ups to verify accuracy.

• Provide ongoing coaching, guidance, and constructive feedback to billing associates.

• Develop and maintain standard operating procedures (SOPs) covering claims processing, payer follow-ups, documentation, compliance, and escalation workflows.

• Regularly review and update SOPs to reflect operational improvements and payer requirements.

• Create training materials, onboarding guides, and practical learning resources for current and incoming team members.

• Establish clear performance expectations, accountability checks, and reporting standards.

• Identify knowledge gaps and implement training or process improvements to strengthen team performance.

• Encourage accuracy, transparency, accountability, and continuous improvement across the billing department.

Reporting, Accountability & Operational Support

• Prepare accurate daily progress reports, billing updates, backlog summaries, and outstanding follow-up plans.

• Track claim submission accuracy, unresolved claims, aging accounts, and reimbursement concerns.

• Verify completed work against actual claim statuses and supporting documentation.

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