Job Title: Medical Billing & Coding Specialist (Primary Care) Position Type: Full-Time Work Hours: 9:00 AM to 6:00 PM Eastern Daylight Time Work Days: Monday to Friday Salary: $6 - $7 per hour, depending on experience Workplace: Remote Preferred Candidate Location: Philippines Our client is a growing U.S.-based healthcare organization dedicated to providing high-quality, patient-centered care. We are seeking a reliable, detail-oriented, and experienced Medical Billing Specialist (Primary Care) to support accurate claims processing, timely reimbursement, and efficient revenue cycle operations. In this role, you will take ownership of assigned medical billing responsibilities, including claims submission, insurance follow-ups, denial and rejection management, accounts receivable (AR), and billing-related documentation reviews. You will also help identify potential reimbursement risks, resolve outstanding claims, and maintain accurate reporting to support a smooth transition to an in-house billing process. The ideal candidate has at least 1 year of hands-on U.S. medical billing experience, a solid understanding of medical coding concepts and payer requirements, and the ability to independently manage billing tasks with accuracy and accountability. Experience in primary care and/or behavioral health billing is highly preferred. If you are an organized, proactive medical billing professional who enjoys solving complex billing issues, improving reimbursement outcomes, and contributing to a growing healthcare team, we'd love to hear from you! Key Responsibilities Medical Billing & Claims Management • Prepare, review, submit, and track medical claims accurately and within payer filing deadlines. • Apply knowledge of ICD-10, CPT, HCPCS, and Evaluation & Management (E/M) billing concepts to identify potential claim errors and documentation gaps. • Investigate pending, rejected, denied, downcoded, or unpaid claims and determine appropriate next steps. • Process claim corrections, resubmissions, reconsiderations, and appeals as needed. • Follow up with insurance payers to resolve outstanding claims and reimbursement issues. • Identify unfiled claims, approaching filing deadlines, and billing backlogs. • Promptly escalate potential reimbursement risks or unresolved billing concerns. • Maintain accurate records of submitted, pending, corrected, and resolved claims. Insurance Verification & Revenue Cycle Management • Verify patient insurance information, eligibility, and coverage when needed. • Communicate with insurance representatives regarding claims, reimbursement, and coverage concerns. • Manage assigned accounts receivable (AR) and follow up on outstanding balances. • Investigate underpayments, payment discrepancies, and delayed reimbursements. • Resolve payer denials, rejections, and downcoding issues through appropriate corrections and appeals. • Assist with payment posting, reconciliation, and billing adjustments. • Identify recurring billing issues and contribute to denial prevention efforts. • Follow applicable payer policies, reimbursement guidelines, and billing requirements. Clinical Documentation, Compliance & Risk Mitigation • Review billing-related clinical documentation to ensure completeness and alignment with submitted claims. • Identify missing, incomplete, or inconsistent documentation that may affect reimbursement. • Coordinate with providers and internal staff to clarify documentation discrepancies. • Verify that documentation supports billed services according to applicable payer requirements. • Perform assigned documentation reviews, compliance checks, and risk mitigation tasks. • Document findings accurately and escalate material compliance or reimbursement concerns. • Stay informed of relevant payer requirements, billing policies, and regulatory updates. • Maintain patient confidentiality and follow HIPAA requirements and organizational procedures. Reporting, Accountability & Operational Support • Maintain accurate daily progress reports detailing claims submitted, pending tasks, follow-ups, and unresolved issues. • Verify claim submission status and supporting documentation before marking tasks as completed. • Maintain transparent and accurate records of billing activities and outcomes. • Collaborate with providers, internal staff, and billing colleagues to resolve issues. • Identify opportunities to improve billing workflows, accuracy, and efficiency. • Support the organization's transition to in-house medical billing operations. • Assist with billing documentation, records management, and related administrative responsibilities. • Communicate potential delays, unresolved concerns, and reimbursement risks promptly. Top 3 Priorities 1. Accurate Claims Submission & Timely Filing Ensure medical claims are complete, accurate, and submitted within payer deadlines. Proactively identify errors, documentation gaps, and unfiled claims to prevent avoidable denials, delayed payments, or lost reimbursement. 2. Accounts Receivable, Denial Resolution & Payer Compliance Take ownership of assigned outstanding claims, denials, rejections, downcoding issues, and appeals. Maintain consistent insurance follow-ups while applying payer requirements and supporting accurate reimbursement. 3. Accountability, Communication & Risk Mitigation Maintain accurate records of completed work, provide transparent progress updates, promptly flag billing and compliance concerns, and collaborate effectively with providers and the internal billing team. What Success Looks Like A successful Medical Billing Specialist consistently demonstrates: • Accurate and timely claims submission. • Strong follow-through on denied, rejected, downcoded, and unpaid claims. • Effective management of assigned accounts receivable. • Timely identification and escalation of filing deadlines, billing backlogs, and reimbursement risks. • Accurate documentation reviews and adherence to payer requirements. • Clear and transparent report