Senior Medical Billing Specialist
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Senior Medical Billing Specialist managing healthcare claims, denials, and payer resolution for global companies. Maintaining compliant RCM operations through EHR validation, clearinghouse work, and reporting.
Responsibilities:
- Prepare and submit clean claims continually for all service lines
- Validate claims against clinical documentation in Ritten.io
- Monitor clearinghouse reports for rejections and errors; correct and resubmit claims
- Maintain claims submission schedules to meet payer deadlines and internal billing cycles
- Own denials, rejections, and unpaid claims through root-cause resolution and successful resubmission
- Contact payers regarding authorizations, eligibility, coding, coordination of benefits, missing documentation, and system errors
- Work with the clearinghouse on transmission issues, file format errors, and claim routing problems
- Document denial reasons, corrective actions, and payer communications
- Analyze denial trends and escalate systemic issues to the Revenue Cycle Manager
- Cross-check claims against clinical encounters and verify required data elements for CalAIM compliance
- Flag documentation gaps to the care team and Revenue Cycle Manager
- Assist with clinical documentation and coding quality assurance reviews
- Maintain billing logs, denial trackers, and A/R aging reports
- Support month-end reconciliation of payments, adjustments, and unresolved claims
- Prepare reports on claim volumes, denial rates, payer trends, and days-in-A/R
- Improve RCM workflows, SOPs, and billing policies
- Coordinate with Authorization Specialists, Care Managers, Supervisors, and Admissions to ensure compliant billing
- Participate in RCM meetings and trainings
Requirements:
- 3–5 years of medical billing, claims follow-up, or payer resolution experience
- Medi-Cal/Medicaid experience preferred
- Experience working claims through clearinghouses, payers, and denial management systems
- Strong understanding of CPT/HCPCS codes, modifiers, ICD-10 codes, and Medicaid billing requirements
- Experience validating claims within an EHR system; Ritten.io experience highly preferred
- Strong Excel/Google Sheets skills, including filters, VLOOKUP, and pivot tables preferred
- Excellent written and verbal communication skills
- Ability to navigate payer conversations professionally
- Highly organized and detail-oriented
- Ability to manage multiple claim queues simultaneously
- Ability to work US time zones (EST–PST)
- Fluent or sufficient English proficiency for professional communication
- Ability to complete a video interview within 24 hours if requested
Benefits:
- Competitive pay
- Real growth opportunities
- Long-term career opportunity
- Remote work
Similar Jobs
Clinical Data Coder
Clinical Data Coder leading medical and medication coding for Indero’s global dermatology and rheumatology clinical trials. Managing coding setups, dictionaries, data reviews, and study timelines.
Senior Clinical Data Coder
Senior Clinical Data Coder leading medical and medication coding for Indero’s global dermatology and rheumatology clinical trials. Managing coding setups, conventions, priorities, and data review.
Inpatient Medical Coder
Remote medical coder assigning emergency department diagnosis, procedure, and E/M codes. Supporting TEKsystems’ business and technology services through accurate charge capture and coding compliance.
Inpatient Medical Coder
Remote medical coder assigning emergency department diagnoses, procedures, modifiers, and facility E/M levels. Supporting TEKsystems’ clients through accurate, compliant medical coding.
Healthcare Billing Specialist
Healthcare Billing Specialist managing U.S. insurance claims, AR, denials, and payer follow-ups for a remote healthcare practice. Maintaining claims in SimplePractice and coordinating billing updates.
Medical Billing & Claims Specialist
Medical Billing & Claims Specialist processing medical procedure claims for a U.S.-based allergy and immunology practice. Managing denials, resubmissions, reimbursement, and billing records.
Certified Coder, Abstractor – Health Information Management
Certified Coder/Abstractor assigning compliant diagnosis and procedure codes for Jefferson Regional Health Information Management. Reviewing patient records and adapting to coding and software changes.
Medical Billing Specialist
Medical Billing Specialist managing TDD infusion-service claims, reimbursements, denials, and collections for A-AIS. Resolving insurance payment issues while ensuring HIPAA and regulatory compliance.
Billing Coordinator I – Healthcare Billing Specialist
Remote Billing Coordinator processing healthcare billing data for Labcorp’s diagnostic testing services. Verifying insurance and demographic information while resolving billing defects.
Medical Billing and Coding Specialist II
Medical billing specialist coding EMS claims for Digitech, a provider of outsourced billing and business-intelligence services for EMS transport. Reviewing claims, ensuring compliance, and meeting accuracy targets.
Medical Coding Auditor – Outpatient
Medical Coding Auditor reviewing outpatient medical records and claims for Humana’s U.S. healthcare and insurance services. Assigning ICD-10-CM and CPT codes while independently determining audit outcomes.
Risk Adjustment Coding Specialist I
Risk adjustment coding specialist validating medical diagnoses and supporting compliant Medicare documentation. Reviewing records, HCC coding, and provider documentation under established guidelines.
Inpatient Corporate Coder
Inpatient coder abstracting clinical records and maintaining coding accuracy for Tenet Healthcare’s hospitals and care services. Reviewing flagged cases, audits, and second-level coding work.
Coding Specialist II – Profee General Pediatrics, Pediatric Hospitalist
Pro Fee coding specialist reviewing pediatric clinical records for Savista’s healthcare revenue-cycle services. Assigning ICD-10 and CPT/HCPCS codes and abstracting compliant billing data.
Ambulatory Coder III, Professional Billing
Remote ambulatory coder validating CPT, ICD-10, and HCPCS codes for Prisma Health healthcare services. Supporting billing compliance, pre-billing edits, provider feedback, and coder training.
Ambulatory Coder III, Professional Billing
Part-time remote ambulatory coder validating CPT, ICD-10, and HCPCS codes for Prisma Health. Supporting professional billing compliance, edits, provider feedback, and coder training.
Inpatient Corporate Coder
Inpatient coder abstracting clinical records and maintaining coding accuracy for Tenet’s hospitals and healthcare services platform. Reviewing flagged cases, audits, and patient documentation remotely across the US.
Coder – Radiology
Remote professional coder supporting OU Health’s Neuro Interventional Radiology revenue integrity. Applying advanced physician coding expertise across complex encounters, claims, denials, and audits.
Coder – Outpatient
Outpatient coder assigning diagnoses, procedures, and E/M codes for Ovation Healthcare. Supporting independent hospitals’ reimbursement, compliance, and quality reporting.
Medical Coder
Medical Coder reviewing E/M and healthcare claims for Cigna’s health services businesses. Ensuring accurate, compliant reimbursement coding across Emergency Department encounters.