Medical Billing & Coding Specialist (Remote | US Client)
Position: Medical Billing & Coding Specialist
Job Type: Full-time (40 hours/week)
Location: Philippines (Remote, EST hours)
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Note: Applicants that don't apply directly will not be considered
Overview
Our client is a growing U.S.-based medical billing organization specializing in maximizing reimbursement for healthcare providers through expert revenue cycle management. As the company continues to expand, they are seeking an experienced Medical Billing & Coding Specialist with a strong background in out-of-network medical billing and reimbursement.This role is ideal for someone who understands the complexities of the U.S. healthcare reimbursement process and can independently manage claims from submission through final payment. The successful candidate will have experience working with commercial insurance carriers, preparing appeals, researching denials, resolving reimbursement issues, and supporting arbitration processes when necessary.
The ideal candidate is detail-oriented, analytical, and persistent in following claims through resolution. They should be comfortable working in a fast-paced remote environment, communicating professionally with insurance companies and healthcare providers, and taking ownership of their assigned billing workload with minimal supervision.
Key Responsibilities
Medical Billing & Claims Management- Review patient documentation to ensure accurate coding and claim preparation
- Prepare, review, and submit accurate medical claims to commercial insurance carriers
- Manage both out-of-network and in-network billing workflows
- Verify diagnosis codes, procedure codes, modifiers, provider information, and insurance details prior to claim submission
- Submit corrected claims, reconsiderations, and appeals when necessary
- Maintain accurate documentation throughout the billing process
- Manage out-of-network reimbursement from claim submission through final resolution
- Support state and federal arbitration and independent dispute resolution processes
- Prepare supporting documentation for appeals, negotiations, and arbitration submissions
- Track reimbursement timelines, payer responses, and arbitration deadlines
- Research payer policies and reimbursement requirements to maximize claim recovery
- Follow up on denied, rejected, unpaid, and underpaid claims
- Investigate claim discrepancies and resolve reimbursement issues
- Review explanations of benefits (EOBs) and electronic remittance advice (ERA)
- Communicate with insurance carriers regarding claim status, payment issues, and appeals
- Assist with medical collections and outstanding account resolution as needed
- Maintain accurate billing records and account documentation
- Protect confidential patient information and maintain HIPAA compliance
- Stay current on coding updates, payer requirements, and reimbursement regulations
- Follow company security and confidentiality policies
- Minimum of 3 years of experience in U.S. medical billing
- Proven experience with out-of-network medical billing is required
- In-network billing experience is strongly preferred
- Strong knowledge of the medical billing and revenue cycle process
- Working knowledge of ICD-10, ICD-9, CPT, HCPCS, and medical terminology
- Experience preparing appeals and resolving denied or underpaid claims
- Strong understanding of state and federal arbitration processes
- Experience communicating with commercial insurance carriers regarding reimbursement issues
- Familiarity with medical collections and account follow-up
- Experience using medical billing software and electronic health record (EHR) systems
- Excellent attention to detail and organizational skills
- Strong written and verbal English communication skills
- Ability to work independently with minimal supervision
- CPC, CPB, or other medical coding or billing certification
- Experience supporting a medical billing or revenue cycle m
