Medical Biller, RCM Specialist
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Job Description
Remote Medical Biller auditing outsourced claims and recovering revenue for a California mental health clinic. Clearing 500+ encounters and preparing full in-house billing transition.
Responsibilities:
- Audit and monitor daily submissions from the external third-party medical billing company
- Cross-reference OnlyMD EMR encounters against filed claims to identify unbilled encounters, coding errors, and dropped tasks
- Investigate approximately 90 days of pending billing and 500+ unsubmitted encounters
- Communicate with payors and the billing agency to resolve claim rejections and denials
- Maintain billing tracking logs and resolve patient insurance eligibility discrepancies in OnlyMD
- Provide Dr. Mann with weekly accounts-receivable recovery reports
- Track claim transmission cadence and flag systematic vendor errors or delays
- Audit CPT/ICD-10 coding for behavioral health encounters, therapy sessions, and psychiatric evaluations
- Identify root causes of unpaid, rejected, or unsubmitted claims and execute corrective actions, appeals, and resubmissions
- Navigate California medical billing regulations, county/state paperwork, and commercial/government payor guidelines
- Document billing workflows and prepare the practice to transition all billing operations in-house
Requirements:
- 3+ years medical billing and coding experience, including AR follow-up, claims auditing, denial management, and medical revenue cycle management (RCM)
- Direct mental/behavioral health billing experience, including psychiatric CPT codes, pre-authorizations, and behavioral health payor rules
- Familiarity with California state billing rules, California payor guidelines, and local paperwork/credentialing requirements
- Experience auditing external billing vendors, tracking missing encounters, and monitoring billing metrics
- Ability to work part-time (~20 hours/week) on a flexible schedule within 10:00 AM–7:00 PM PST, with full availability to transition to 40 hours/week full-time
- Dedicated, private, quiet HIPAA-compliant home office
- High-performance PC or Mac, high-speed internet, backup internet/power solutions, and a headset
- Hands-on OnlyMD EMR & Billing System or comparable integrated EMR/billing system experience preferred
- Experience transitioning a clinic from outsourced billing to in-house billing preferred
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