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 I CD-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…