Virtual Medical Biller / Revenue Cycle Management (RCM) Specialist

We are seeking an exceptionally analytical, detail-oriented, and results-driven Virtual Medical Biller / Revenue Cycle Management (RCM) Specialist to manage the financial operations of our medical practice. Operating in a high-volume specialty environment, our brand represents financial integrity, meticulous compliance, and elite operational performance.

This position is a dynamic, high-engagement financial operation designed to solve our clinic's most critical operational bottleneck: an accumulation of unresolved claims. We need a dedicated billing professional to systematically audit our history, resolve outstanding accounts receivable, and optimize the overall revenue cycle. You will serve as the primary engine driving our revenue recovery.

Schedule & Daily Focus

Schedule: Full-Time, 40 hours per week | Monday – Thursday, 7:00 AM – 5:00 PM (US Timezone TBD) | Enjoy a 3-day weekend!

Immediate Priority: Backlog & Billing Cleanup (First few weeks)

The primary challenge currently facing our clinic—and the driving force behind this hire—is a backlog of incorrect billing submissions and unbilled procedures. Your immediate focus during your first few weeks will be to:

• Backtrack, audit, and correct historic billing filings that were submitted incorrectly.
• Identify, compile, and bill outstanding, unbilled procedures.
• Audit and capture neglected or unpaid patient/insurance payments to restore billing health.

Standard Top 3 Daily Tasks (Post-Cleanup)

1. Accounts Receivable (A/R) Management: Reviewing aging reports, prioritizing outstanding balances, and actively pursuing aging claims.
2. Revenue Cycle Management & Claims: Overseeing the complete claim lifecycle from clean submission through final payment optimization.
3. Payer & Patient Phone Calls: Confidently handling inbound and outbound calls to resolve billing inquiries and negotiate with insurance adjusters.

Core Responsibilities

Accounts Receivable & Revenue Recovery

• End-to-End RCM Oversight: Manage the full medical billing lifecycle, ensuring clean claim submission, monitoring processing status, and securing timely reimbursements.
• Aggressive A/R Reduction: Audit aging reports to identify, research, and systematically resolve unpaid, delayed, or underpaid claims with insurance carriers.
• Denials & Appeals Navigation: Deeply investigate denied or rejected claims to pinpoint root causes, correct billing or modifier errors, and submit robust appeals to recover revenue.

Insurance Verification & Phone Operations

• Insurance Benefit Navigation: Execute comprehensive insurance eligibility and benefit verifications, ensuring active coverage is accurately documented.
• Elite Phone Management: Command inbound and outbound lines with a highly articulate, professional, and confident presence when communicating with insurance companies and handling patient billing inquiries.
• EHR Documentation Excellence: Maintain meticulous documentation of all collection efforts, backlog auditing, and financial adjustments within the ModMed (EMA) ecosystem.

Requirements

• Medical Billing Domain Expertise: Proven experience in U.S. medical billing, accounts receivable, and collections. Prior experience in Ophthalmology or Retina billing is highly preferred.
• Backlog Recovery Experience: Proven track record of auditing historical billing records, identifying missing/unbilled procedures, and successfully reconciling aged accounts.
• Software Literacy: Direct hands-on experience navigating ModMed (EMA) EHR is a strong plus. Technical proficiency with medical clearinghouses and digital billing workflows is required.
• Phonetic & Verbal Excellence: Flawless verbal and written English communication skills. Must possess an exceptionally clear, professional phone voice and the ability to articulate complex billing guidelines.
• Insurance Fluency: Solid, practical understanding of commercial insurance structures, claims tracking, CPT/ICD-10 coding guidelines, and modifier usage.
• Remote Workspace: Ability to work independently from a completely silent, distraction-free virtual home office equipped with high-speed internet and a professional headset.

Ideal Candidate Profile

The ideal candidate thrives on "clean-up" projects and takes complete ownership of revenue recovery. You are a billing detective who enjoys looking at historic ledgers, identifying where filings went wrong, and capturing money left on the table. You are proactive, highly analytical, and ready to make an immediate financial impact.