Job Title: Medical Billing & Prior Authorization Specialist
Position Type: Full-Time
Work Hours: 9:00 AM – 6:00 PM Central Time (with 1-hour unpaid lunch break)
Work Days: Monday – Friday
Weekend Availability: 1–2 hours on weekends, only as needed (Saturday and Sunday, around 1:00 PM Central Time, 1 hour each for follow-ups)
Salary: $5–7 per hour, depending on experience
Workplace: Remote
Preferred Candidate Location: Philippines
About the Role
Our Client is looking for an experienced and detail-oriented Medical Billing & Prior Authorization Specialist to join a well-established, US-based psychology and psychiatry practice.
The clinic provides comprehensive mental and behavioral healthcare services, including psychotherapy, psychological evaluations, neurofeedback, and Transcranial Magnetic Stimulation (TMS). With approximately six providers serving 30–50 patients daily, the practice is committed to delivering quality patient care while maintaining efficient administrative and billing operations.
The ideal candidate has hands-on experience with US healthcare insurance billing, claims processing, and prior authorizations. You will initially support the clinic's billing operations, including covering responsibilities during an existing team member's maternity leave, before transitioning into a long-term collaborative billing role.
This opportunity is ideal for someone who is organized, proactive, comfortable communicating with insurance companies and patients, and interested in growing within a healthcare practice.
Key Responsibilities
Medical Billing & Insurance Claims Processing (Top Priority)
• Manage and process approximately 20–30 US healthcare insurance claims daily, ensuring accurate and timely submissions.
• Review billing information, insurance coverage, provider details, and documentation before submitting claims.
• Identify and resolve billing discrepancies, rejected claims, and processing issues.
• Ensure accurate billing for services involving psychologists, psychiatrists, and doctoral interns, following applicable payer requirements.
• Coordinate with insurance companies to resolve claims-related concerns and maintain proper reimbursement workflows.
Prior Authorization Management
• Handle prior authorization requests for applicable behavioral health and psychiatric services.
• Verify insurance requirements, coverage limitations, and authorization status.
• Coordinate with providers, insurance companies, and internal staff to obtain necessary documentation.
• Track pending authorizations, follow up on outstanding requests, and prevent delays in patient services.
• Maintain accurate records of authorization approvals, denials, and expiration dates.
Billing Follow-Up & Administrative Support
• Follow up on unpaid, pending, rejected, or denied insurance claims.
• Contact insurance companies to clarify claim statuses, payment discrepancies, and billing requirements.
• Maintain organized billing records and track outstanding tasks.
• Assist in documenting billing procedures and improving administrative workflows.
• Collaborate with the existing billing specialist and clinical team to ensure continuity of billing operations.
Patient Communication & Clinic Coordination
• Conduct outreach and communicate with other clinics, insurance representatives, and patients as needed.
• Assist patients in understanding their insurance benefits, coverage, and billing responsibilities within the scope of the role.
• Provide general information about the clinic's services and assist with service-related inquiries.
• Handle inbound and outbound calls professionally using RingCentral.
• Support additional administrative responsibilities as assigned, with training provided.
Systems & Tools
• TherapyNotes: Current practice management and EHR platform.
• Tebra: Planned EHR transition in January 2027.
• RingCentral: Phone communication and coordination.
• Insurance payer portals: For eligibility verification, claims processing, prior…