Medical Billing & RCM Specialist

About the Role

The ideal candidate has strong hands-on experience with U.S. medical billing, claims, denials, unpaid claims, insurance verification, and prior authorizations. This role requires someone detail-oriented, organized, proactive, and comfortable working independently across multiple healthcare systems.

Key Responsibilities

• Manage day-to-day medical billing and Revenue Cycle Management (RCM).
• Prepare, submit, and track medical claims through payment.
• Investigate and resolve claim denials, rejections, and unpaid claims.
• Follow up with insurance companies regarding outstanding claims and reimbursement.
• Perform insurance eligibility and benefits verification.
• Process and track prior authorizations and ensure proper documentation.
• Work extensively with Optum, which covers the majority of the practice's patients.
• Maintain accurate patient, billing, insurance, referral, and authorization records.
• Use Office Ally and other systems, including insurance portals, clearinghouses, Square, spreadsheets, and shared drives.
• Maintain clear documentation of billing activities and unresolved issues.
• Communicate professionally with insurance representatives, patients, and healthcare offices as needed.
• Follow established SOPs and workflows while maintaining HIPAA compliance.

Requirements

• U.S. healthcare experience is required.
• Medical Billing and RCM experience is required.
• Experience handling claims from submission through payment.
• Experience resolving denials, rejections, and unpaid claims.
• Insurance verification and prior authorization experience is required.
• Experience using healthcare billing, EHR, or practice management systems.
• Office Ally experience is highly preferred.
• Optum experience is a strong advantage.
• Experience with insurance portals and clearinghouses.
• Strong understanding of U.S. medical billing and insurance workflows.
• Previous remote/VA experience is preferred but not required.
• No medical degree or clinical license is required.

Skills & Basic Requirements

• Strong attention to detail, organization, and problem-solving skills.
• Ability to manage multiple claims, follow-ups, and deadlines.
• Strong written and verbal English communication skills.
• Professional phone communication skills.
• Ability to work independently and follow detailed SOPs.
• Knowledge of HIPAA compliance; certification is preferred.

Technical Requirements

• Computer: Reliable laptop or desktop computer.
• Internet: Stable high-speed internet connection (minimum 25 Mbps).
• Audio: Noise-canceling headset.
• Video: Working webcam for virtual meetings.
• Workspace: Quiet and professional work environment.

Benefits

• Dedicated HR & Contractor Support Team: Access to world-class support for questions, guidance, contract matters, and client communication.
• Premium VPN Access (Optional): A secure VPN license can be provided upon request to enhance privacy and security for client-related tasks.
• HIPAA & Cybersecurity Training + Certification (Provided): Access to our internal HIPAA compliance training, cybersecurity modules, and certification.
• Top 1% VA Performance Training: Access to proprietary training on communication, client management, productivity systems, and best practices.
• Client-Approved U.S. Holidays: Contractors may take U.S. holidays off according to the client’s needs.
• Client-Approved Paid or Unpaid Time Off: Time off may be granted by your client.
• Access to Tools & Resources: Templates, workflow guides, productivity tools, and client-specific SOP support.
• Optional Performance-Based Incentives: Some clients may offer bonuses, incentives, or increased hours based on performance.