Employment Details:
- Employment Type: Independent Contractor, Full-Time or Part-Time.
- Work Arrangement: Fully Remote.
- Hours: 15 to 40 hours per week.
- Schedule: U.S. business hours based on client requirements and agreed availability.
- Time Zones: U.S. Eastern, Central, or Pacific Time.
Role Overview:
- We are seeking an experienced Bilingual Senior Medical Billing Specialist who is fluent in English and Spanish and has strong hands-on experience managing the U.S. healthcare billing and revenue cycle process.
- This is a hands-on senior-level billing role for a professional who can independently manage billing workflows, claims, denials, accounts receivable, payment issues, and insurance follow-up within a U.S. healthcare environment.
- The ideal candidate will have at least 3 years of direct U.S. healthcare medical billing experience, preferably within a medical practice, clinic, behavioral health organization, ophthalmology practice, dental practice, or other U.S. healthcare setting.
- Candidates should be comfortable working across multiple stages of the revenue cycle and should have practical knowledge of medical billing, coding, claims management, denial resolution, AR follow-up, and payer processes.
Key Responsibilities:
- Manage day-to-day U.S. medical billing and revenue cycle activities.
- Prepare, review, and submit accurate claims to Medicare, Medicaid, and commercial insurance payers.
- Review patient accounts, medical records, charges, and insurance information for billing accuracy.
- Apply and interpret CPT, ICD-10-CM, HCPCS, and applicable modifiers based on the practice's requirements.
- Identify and correct billing and coding errors before or after claim submission.
- Manage claim rejections, denials, corrections, appeals, and resubmissions.
- Perform Accounts Receivable follow-up on outstanding and aging claims.
- Investigate unpaid, underpaid, and incorrectly processed claims and follow up with insurance payers.
- Review EOBs and ERAs and reconcile payments against patient accounts.
- Perform or support payment posting and account reconciliation as required.
- Verify patient eligibility, insurance information, and benefits when required.
- Work with payer portals, clearinghouses, and billing systems to research and resolve claim issues.
- Monitor outstanding Accounts Receivable and take appropriate action to move accounts toward resolution.
- Identify recurring billing, coding, denial, or payment issues and communicate trends to the appropriate team.
- Communicate professionally with insurance companies, providers, patients, and internal teams.
- Maintain accurate billing documentation and follow client-specific processes and compliance requirements.
- Work independently in a remote environment while meeting accuracy, productivity, and turnaround-time expectations.
Required Qualifications:
- Minimum 3 years of hands-on experience in U.S. medical billing, preferably in a medical practice, clinic, or healthcare organization.
- Direct experience supporting the U.S. healthcare revenue cycle.
- Medical Billing.
- Medical Coding.
- CPT.
- ICD-10-CM.
- HCPCS.
- Claims Submission.
- Denial Management.
- Accounts Receivable.
- Insurance or Payer Follow-up.
- Revenue Cycle Management.
- Experience working with U.S. insurance payers, including commercial insurance and/or Medicare or Medicaid.
- Working knowledge of EHR or EMR systems, clearinghouses, payer portals, or healthcare billing software.
- Fluent in English and Spanish, with the ability to communicate professionally in both languages.
- Strong attention to detail and ability to independently manage billing tasks and follow up on outstanding accounts.
- Comfortable working remotely and meeting client-specific productivity and quality expectations.
