Medical Biller & Revenue Cycle Specialist

Remote | Behavioral Health | 30 hours/week | 11:00 AM to 7:00 PM US Central
$6.5-$7.5/hour + 6th month performance review

Role Overview

We are seeking an experienced Medical Biller & Revenue Cycle Specialist to support a nonprofit behavioral health organization in the United States.

This is an experienced-level position for someone who can independently oversee and strengthen the clinic's medical billing and revenue cycle processes.

The clinic's clinicians document their visits in AdvancedMD and enter the applicable billing codes and initial charge information. The Medical Biller will review that information, ensure billing activity is accurate and timely, process and track claims, manage denials and outstanding Accounts Receivable, support payment reconciliation, monitor revenue-cycle performance, and help establish reliable billing procedures.

The organization is looking for more than someone who can simply process assigned claims. The successful candidate will serve as a billing subject-matter resource, identify problems the clinic may not yet recognize, recommend solutions, and help develop effective Standard Operating Procedures.

This role requires someone who can become productive with limited billing-specific training.

Key Responsibilities

Billing & Charge Review

• Review clinician-entered documentation, billing codes, charge information, and charge slips for completeness and accuracy before claims are processed.

• Identify missing, inconsistent, or potentially incorrect billing information that could affect claim acceptance or reimbursement.

• Coordinate with clinicians or appropriate team members when documentation, coding, or charge information requires correction or clarification.

Coding Validation

• Review applicable ICD-10, CPT, HCPCS, and modifier information for consistency with documented services.

• Identify coding or documentation issues that may contribute to claim rejection, denial, underpayment, or compliance concerns.

• Apply strong coding knowledge to validate clinician-entered information while following established clinic and payer requirements.

Claim Creation & Submission

• Compile and validate patient, provider, payer, diagnosis, procedure, and service information required for claim submission.

• Submit complete claims through AdvancedMD, clearinghouse workflows, or applicable payer processes in a timely manner.

• Monitor submission confirmations and promptly correct claims that are rejected before or during payer processing.

Claim Adjudication

• Monitor submitted claims throughout the payer adjudication process for approval, rejection, denial, underpayment, or other outcomes.

• Review payer responses and determine what action is necessary to move unresolved claims toward payment.

• Maintain accurate documentation of claim status, payer communication, corrective actions, and next steps.

Denial Management & Appeals

• Research denied or rejected claims to determine root cause and identify the appropriate corrective action.

• Resubmit corrected claims or prepare reconsiderations and appeals with the necessary supporting documentation.

• Track outstanding denials and appeals through resolution while identifying recurring issues that should be prevented in future claims.

Accounts Receivable Follow-Up

• Review and prioritize outstanding Accounts Receivable based on aging, payer, claim status, value, and urgency.

• Follow up directly with insurance companies regarding unpaid, delayed, incorrectly processed, or unresolved claims.

• Monitor timely filing and appeal deadlines to reduce avoidable revenue loss.

Payment Posting & Reconciliation

• Post insurance payments, contractual adjustments, deductibles, copays, coinsurance, and other applicable amounts accurately.

• Reconcile payments and adjustments against EOBs, ERAs, and available payer information.

• Investigate underpayments, overpayments, posting discrepancies, or unexpected reimbursement differences.

Patient Billing

• Review remaining patient responsibility after insurance adjudication and confirm that patient balances are accurate.

• Generate or validate patient statements and support established payment-plan or online payment processes when required.

• Respond professionally to patient billing inquiries and explain account information within the appropriate scope of the role.

Provider Credentialing

• Assist with new provider payer enrollment, credentialing applications, attestations, and required supporting documentation.

• Monitor credentialing applications, payer responses, recredentialing requirements, and expiration dates.

• Follow up with insurance plans regarding pending applications or outstanding enrollment requirements.

Billing Reporting & KPI Monitoring

• Monitor key revenue-cycle indicators including denial rates, Days in Accounts Receivable, AR aging, outstanding claims, and collection performance.

• Prepare billing and claims status reports and identify payer, denial, reimbursement, or workflow trends requiring attention.

• Communicate significant findings and recommend actions that may improve reimbursement and revenue-cycle performance.

Auditing & Compliance

• Conduct internal reviews of billing activity to identify errors, documentation problems, compliance concerns, and workflow gaps.

• Review recurring billing or payer issues that may be contributing to unnecessary denials, delayed payment, or revenue loss.

• Help ensure billing activities follow applicable clinic procedures, payer requirements, HIPAA standards, and healthcare regulations.

Process Improvement

• Analyze recurring billing, coding, documentation, AR, and payer issues to identify their underlying causes.

• Recommend workflow improvements that may reduce errors, improve collections, and create more consistent billing performance.

• Proactively bring billing concerns and improvement opportunities to clinic leadership rather than waiting for problems to escalate.

SOP Development

• Document workflows for charge review, claim submission, denials, AR follow-up, appeals, and payment posting.

• Help establish standardized procedures for credentialing, billing reporting, patient balances, and internal audits.

• Update billing SOPs as payer requirements, clinic processes, and operational needs evolve.

Required Qualifications

• Minimum 2 years of medical billing, revenue cycle management, coding, or closely related US healthcare billing experience.

• Strong understanding of the end-to-end US medical billing lifecycle.

• Strong working knowledge of ICD-10, CPT, and HCPCS coding systems.

• Experience with claim creation and submission.

• Experience managing denied and rejected claims.

• Experience with Accounts Receivable follow-up.

• Experience communicating directly with US insurance companies.

• Understanding of EOBs, ERAs, payment posting, and patient responsibility.

• Experience using medical billing software and EHR systems.

• Ability to independently research and resolve claim issues.

• Strong analytical, organizational, and problem-solving skills.

• Exceptional attention to detail and accuracy.

• Professional written and verbal communication skills.

• Strong HIPAA and healthcare compliance awareness.

• Ability to work independently with limited supervision.

• Reliable and punctual attendance.

Preferred Qualifications

• Previous experience using AdvancedMD.

• Behavioral health or mental health billing experience.

• Medicaid billing experience.

• Provider credentialing and payer enrollment experience.

• Experience creating medical billing SOPs.

• Experience performing revenue-cycle audits.

• Experience analyzing billing KPIs and AR performance.

• Demonstrated experience reducing denials, resolving aged AR, or improving billing workflows.

Systems & Tools

The primary billing and EHR platform is:

• AdvancedMD

The position may also use:

• Insurance payer portals

• Clearinghouse systems

• Microsoft Teams

• Phone services

• Reporting and spreadsheet tools

• VPN and secure remote-access systems

• Time Doctor

Remote Work Requirements

Candidates must maintain:

• Dedicated private workspace suitable for confidential healthcare and financial information

• Reliable computer capable of supporting AdvancedMD and other billing applications

• Stable primary internet connection

• Reliable backup internet

• Verified backup power source

• Secure and professional remote working environment

• Strong information-security and HIPAA practices