About the Role

We are seeking a seasoned, revenue-focused Medical Biller / RCM Specialist to take full ownership of our practice’s complete revenue cycle. You will oversee all billing operations for an Internal Medicine and Pediatrics practice with subspecialties in Obesity Medicine and Nutrition.

This is a dedicated, specialized billing role—not a general virtual assistant or front-office position. You will manage the entire lifecycle of a claim, from pre-visit eligibility and prior authorizations to charge review, electronic claim submission, payment posting, aggressive A/R follow-up, denial resolution, and patient collections.

Requirements

Key Responsibilities

1. Full-Cycle Claims & Payment Processing

• Review charges and claims for complete billing accuracy; validate CPT, HCPCS, and ICD-10 coding.
• Submit clean claims electronically, monitor daily clearinghouse statuses, and promptly correct and resubmit rejected claims.
• Accurately post insurance payments (EOBs/ERAs) and patient payments; balance posting logs daily.

2. Denials Management & Appeals

• Interrogate denial codes, identify root causes, and correct/resubmit claims immediately.
• Draft and submit comprehensive appeal packages complete with supporting clinical documentation.
• Track appeals through final resolution and identify recurring denial patterns to recommend preventative workflow adjustments.

3. Proactive A/R & Collections

• Proactively work aging reports ($30/60/90+$ days) to resolve unpaid or underpaid claims long before timely-filing windows close.
• Contact payers directly to negotiate and resolve outstanding claim balances.
• Manage patient billing statements, set up payment plans, handle patient balance collection inquiries, and document every step of the resolution process in the EMR.

4. Insurance Verification & Prior Authorizations

• Perform detailed insurance eligibility checks, verifying deductibles, copays, coinsurance, network status, and coordination of benefits.
• Identify services, procedures, and medications requiring prior authorization; compile and submit necessary documentation.
• Track authorization requests, maintain current expiration dates in patient records, and handle auth-related appeal escalations (especially critical for weight-loss medications).

5. Administrative & Communication Support

• Monitor incoming electronic faxes for payer determinations, authorization approvals, and claim correspondence; route and document all paperwork within eClinicalWorks.
• Utilize our Telzio VOIP phone system to handle inbound and outbound billing calls with payers and patients.

Mandatory Requirements

• Experience: Minimum of 3+ years of hands-on, full-cycle U.S. medical billing and RCM experience.
• Core Competencies: Extensive background in claim submissions, A/R follow-up, payment posting, complex denial/appeals workflows, patient collections, and eligibility/prior auths.
• Coding Mastery: Strong proficiency with standard CPT, HCPCS, ICD-10 coding, and modifier usage.
• Communication: Exceptional written and spoken English skills; comfortable calling insurance representatives and speaking with patients.
• Compliance: Thorough understanding of HIPAA regulations, patient privacy laws, and medical records handling.

Preferred Qualifications (High Priority)

• EMR: Recent, hands-on experience using eClinicalWorks (eCW)—you must be comfortable navigating eCW with minimal system-specific training.
• Specialty Expertise: Billing experience in Internal Medicine, Pediatrics, or specialized Obesity Medicine / Weight Management / Nutrition practices.
• Medication Auth Experience: Prior success securing approvals and managing denials for weight-management and chronic disease medications.
• Software Tools: Familiarity with Telzio VOIP or similar softphone applications, along with digital fax management workflows.