Senior Medical Billing & Coding Specialist - Philippines

Employment Type: Independent Contractor | Full-Time & Part-Time
Work Arrangement: Fully Remote | Specific working hours will depend on the client's requirements.
Hours: 15–40 hours per week
Time Zones: U.S. Eastern, Central, or Pacific Time

About the Role

We are seeking an experienced Senior Medical Billing & Coding Specialist with strong hands-on experience supporting U.S. healthcare practices .

The ideal candidate will have at least 3 years of direct experience in U.S. healthcare billing and coding , preferably working within an actual medical practice or healthcare organization such as Primary Care, Behavioral Health, Mental Health, Dental, Ophthalmology, or another specialty practice .

This is a hands-on role for a professional who understands the U.S. healthcare revenue cycle and can independently manage billing, coding, claims, denials, Accounts Receivable (AR), and payer-related processes.

Key Responsibilities

- Handle day-to-day U.S. medical billing and coding activities.

- Prepare, review, and submit accurate claims to Medicare, Medicaid, and commercial insurance payers .

- Review medical records and billing information to ensure accurate coding and claims submission.

- Apply and interpret CPT, ICD-10, HCPCS, and appropriate modifiers .

- Identify and correct billing and coding errors that may result in claim rejections or denials.

- Manage denials, rejected claims, appeals, and claim corrections .

- Perform Accounts Receivable (AR) follow-up and resolve outstanding insurance balances.

- Investigate unpaid, underpaid, and denied claims and follow up with insurance companies.

- Support the complete Revenue Cycle Management (RCM) process.

- Review EOBs and ERAs and reconcile payments against submitted claims.

- Perform payment posting and identify discrepancies where applicable.

- Verify and maintain accurate patient and insurance information.

- Work with payer portals, clearinghouses, EHR/EMR systems, and billing platforms.

- Identify recurring billing and denial issues and recommend improvements.

- Maintain accurate records and documentation.

- Communicate professionally with insurance companies, healthcare providers, patients, and internal teams when required.

- Follow client-specific billing, coding, compliance, and workflow requirements.

Required Qualifications

- Minimum 3 years of hands-on U.S. medical billing and coding experience.

- Direct experience working within a U.S. healthcare practice, clinic, or healthcare organization .

- Experience supporting one or more healthcare specialties, such as: Primary Care / Family Medicine, Behavioral Health, Mental Health, Dental, Ophthalmology, Specialty Care, & Other U.S. healthcare practice environments

- Strong understanding of the U.S. healthcare Revenue Cycle Management (RCM) process.

- Hands-on experience with: Medical Billing, Medical Coding, Claims Submission, Denial Management, Accounts Receivable (AR), Claim Follow-up, Payment Posting, Insurance Verification and/or Eligibility

- Experience working with Medicare, Medicaid, and commercial insurance .

- Strong understanding of CPT codes , with working knowledge of ICD-10, HCPCS, and modifiers.

- Ability to review claims and identify billing or coding discrepancies.

- Strong understanding of insurance payer processes and requirements.

- Strong computer skills and ability to work with healthcare software, EHRs/EMRs, clearinghouses, and payer portals.

- Excellent written and verbal English communication skills .

- Strong attention to detail and accuracy.

- Ability to work independently in a remote environment.

Preferred Qualifications

- Experience working directly within a specific U.S. healthcare practice or specialty.

- Experience handling complex denials, appeals, and aging AR .

- Experience with multiple insurance payer portals and clearinghouses.

- Experience with healthcare EHR/EMR and practice management systems.

- Medical billing or coding certification such as