Senior Billing Specialist

The Senior Revenue Cycle Management (RCM) Specialist is responsible for managing, optimizing, and overseeing the full revenue cycle process across insurance verification, charge capture, coding review, claims submission, denials management, and collections. This individual serves as the subject-matter expert and escalation point for complex payer, coding, or reimbursement issues. The Senior RCM Specialist helps drive financial performance and ensures compliance with industry standards and payer regulations.

Work Setup: Onsite in Eastwood, Quezon City, Philippines.

Key Responsibilities

1. Claims Processing & Billing Oversight

• Prepare, review, and submit accurate claims (electronic and paper) to commercial payers,

government programs, and managed care organizations.

• Review charge capture accuracy and verify appropriate coding (CPT, ICD-10, HCPCS).

• Correct errors on rejected or unprocessed claims to ensure timely resubmission.

2. Insurance Verification & Prior Authorizations

• Lead advanced eligibility verification, ensuring correct benefits classification and coverage details.

• Confirm prior authorization requirements and resolve escalated issues impacting claim approval.

3. Denials, Appeals, & A/R Management

• Conduct detailed analysis of denials and identify root causes to reduce future occurrences.

• Prepare structured appeals with supporting documentation for complex payer disputes.

• Manage and reduce aged accounts receivable through strategic follow-ups and payer

communication.

4. Payment Posting & Reconciliation

• Oversee the accurate posting of payments, adjustments, and patient responsibilities from ERAs

and EOBs.

• Identify underpayments, incorrect payer adjustments, and escalate discrepancies as needed.

5. Compliance & Quality Assurance

• Ensure all billing activities adhere to payer policies, CMS guidelines, HIPAA, and internal

compliance standards.

• Maintain updated knowledge of regulatory or policy changes affecting revenue cycle operations.

6. Reporting & Process Improvement

• Prepare performance reports including: A/R aging, denial trends, claim lag time, and collection

metrics.

• Identify workflow inefficiencies and lead improvements to optimize revenue capture.

• Provide guidance and mentorship to junior billing and RCM staff.

7. Cross-Functional Collaboration

• Communicate with providers, coders, clinical teams, and leadership regarding billing issues or

documentation needs.

• Serve as the primary resource for complex RCM inquiries and payer interpretation.

Required Qualifications Education:

• Bachelor’s degree in Healthcare Administration, Business, Finance, or related field (preferred). Experience
• Minimum of 5 years of hands-on experience in U.S. medical billing and revenue cycle management.
• Strong expertise in insurance guidelines, reimbursement methodologies, and denial management strategies.
• Experience with common EMR/EHR and billing platforms (e.g., Athena, Kareo, eCW, DrChrono, Epic). Skills
• Deep knowledge of CPT, ICD-10, and HCPCS coding principles.
• Strong analytical, organizational, and problem-solving ability.
• Excellent written and verbal communication for working with payers and providers.
• Ability to work independently, prioritize workload, and lead process improvement initiatives.
• High accuracy and attention to detail.