Description:
Role Overview: As a Medical Billing Specialist, you will be responsible for managing end-to-end billing workflows for assigned providers, with a focus on PCP, Behavioral Health, and Chiropractic practices. You will handle everything from eligibility verification to claim submission, denial resolution, and payment reconciliation, ensuring accurate and timely reimbursements. This role requires hands-on expertise, attention to detail, and the ability to work independently in a fast-paced environment.
Key Responsibilities:
- Eligibility, Benefits & Pre-Authorizations: Verify patient eligibility and benefits with insurance payers, obtain and document pre-authorizations where required, and ensure accurate coverage details before claim submission.
- Claim Management & Submission: Prepare and submit clean claims for PCP, Behavioral Health, and Chiropractic services, apply correct CPT codes, ICD-10 codes, and modifiers specific to each specialty, and ensure compliance with payer guidelines and billing regulations.
- Accounts Receivable & Denial Management: Handle denials and rejections specific to PCP, Behavioral Health, and Chiropractic billing, identify root causes and take corrective actions, submit appeals and rework claims to ensure maximum reimbursement, and follow up consistently with insurance companies for claim resolution
- Payment Posting & Reconciliation: Accurately post payments, adjustments, and denials, review EOBs/ERAs and resolve discrepancies, and maintain and manage AR aging reports
- Workflow Management: Independently manage day-to-day billing operations, ensure timely submission, follow-ups, and resolution of claims, and maintain proper documentation and reporting across all billing activities
- Systems & Tools: Work on leading EHRs including SimplePractice, ChiroFusion, TheraNest, TherapyNotes, Dr Chrono, and similar platforms, and maintain accurate data within billing systems and internal tools
Requirements:
- Minimum 1-2+ years of hands-on experience in U.S. medical billing
- Proven experience in PCP, Behavioral Health, and Chiropractic billing (mandatory)
- Strong understanding of CPT codes, modifiers, and payer-specific billing requirements
- Demonstrated experience in denial handling and AR follow-ups for these specialties
- Experience with Eligibility Verification, Benefits, and Pre-Authorizations
- Familiarity with EHRs such as SimplePractice, ChiroFusion, TheraNest, TherapyNotes, DrChrono
- Excellent English communication skills (verbal and written)
- Strong attention to detail, problem-solving, and time management skills
- Must be available for night shift (06:00 PM - 03:00 AM PKT)
- Must have a personal laptop and a reliable, high-speed internet connection