Senior Medical Biller

We are looking for an experienced Senior Medical Biller with 7+ years of hands-on experience in US Healthcare Provider-side Revenue Cycle Management (RCM), particularly in Accounts Receivable (A/R), Denial Management, Appeals, Payment Posting, and Collections.

The successful candidate will independently manage assigned billing accounts, perform end-to-end claim follow-up, identify and resolve denial and payment issues, prepare appeals, and work directly with healthcare practices and insurance payers.

This is a client-facing position, so strong communication, relationship management, analytical ability, and professional judgment are essential.

Key Responsibilities

1. Medical Billing & Revenue Cycle Management

• Manage the complete medical billing and collections cycle for assigned client accounts.
• Ensure claims are accurately prepared, submitted, and followed up within payer timelines.
• Perform insurance verification, claim status checks, payment research, and account follow-up.
• Work extensively with insurance portals including Medicare, Medicaid, CHAMPS, and other payer platforms.
• Ensure timely resolution of billing issues to maximize reimbursement and reduce outstanding A/R.
• Maintain accurate documentation of all billing activities and account actions.

2. A/R & Denial Management

• Perform detailed A/R follow-up on outstanding and aged accounts.
• Analyze A/R reports to identify trends, payment delays, underpayments, and high A/R days.
• Investigate and resolve claim denials, rejections, and payment discrepancies.
• Identify recurring denial patterns and perform root cause analysis (RCA).
• Track and document top denial reasons and apply appropriate denial codes in the billing system.
• Develop appropriate action plans to reduce recurring denials.
• Maintain consistent follow-up on unresolved claims until appropriate resolution.

3. Appeals & Reconsiderations

• Prepare and submit payer appeals and reconsideration requests for denied claims.
• Handle Medicare reconsiderations/appeals in accordance with applicable procedures.
• Demonstrate a strong understanding of the documentation and information required to support an appeal.
• Understand and appropriately handle processes related to ABN (Advance Beneficiary Notice) and COB (Coordination of Benefits).
• Research payer policies and supporting documentation to strengthen appeal outcomes.
• Monitor appeal status and ensure timely follow-up through resolution.

4. Payment Posting & Reconciliation

• Review and interpret EOBs (Explanation of Benefits) and payment vouchers.
• Post insurance and patient payments accurately in the billing system.
• Reconcile payments against claims and identify discrepancies, contractual adjustments, and underpayments.
• Research and resolve payment posting issues.
• Ensure all financial transactions are properly documented and supported.

5. Medical Coding & Claims Accuracy

• Apply a strong working knowledge of ICD-10 and CPT coding requirements.
• Review claims for billing accuracy and payer-specific requirements.
• Identify coding-related issues that may contribute to denials or delayed reimbursement.
• Work with relevant internal teams to resolve coding and documentation issues.

6. Client & Payer Communication

• Communicate directly with healthcare practices regarding billing clarifications, documentation requirements, claim issues, and dispute resolution.
• Maintain professional and effective relationships with clients and payer representatives.
• Contact insurance companies and payer representatives to research claim status and resolve outstanding issues.
• Clearly document all payer and client interactions.
• Perform post-call analysis and record appropriate after-call actions for claim follow-ups.

7. Compliance & Documentation

• Maintain strict compliance with HIPAA requirements related to patient privacy, access, and release of information.
• Follow payer-specific regulations, healthcare compliance requirements, company policies, and established billing procedures.
• Maintain complete and accurate documentation within client software and billing systems.
• Ensure documentation supports insurance submissions and provides a clear audit trail.
• Stay current with changes in payer policies, billing guidelines, and healthcare regulations.

8. Process Improvement & Reporting

• Analyze billing and A/R data to identify operational issues and improvement opportunities.
• Provide regular reporting on A/R, denials, appeals, collections, and account performance.
• Identify trends and recommend corrective actions to improve revenue cycle performance.
• Collaborate with internal teams to reduce denials and improve billing efficiency.
• Contribute to process standardization and continuous improvement initiatives.

Must-Have Skills

• 7+ years of experience in US Healthcare Provider-side RCM.

• Strong hands-on experience in:

• A/R Follow-up

• Denial Management

• Medical Billing

• Appeals & Reconsiderations

• Payment Posting

• Collections

• Strong understanding of the US healthcare revenue cycle.

• Experience working with Medicare and Medicaid.

• Hands-on experience with insurance portals such as CHAMPS, Medicare, and Medicaid.

• Strong understanding of EOBs, claim status, payment vouchers, denials, and payer processes.

• Strong knowledge of ICD-10 and CPT coding concepts.

• Understanding of HIPAA and healthcare compliance requirements.

• Excellent written and verbal communication skills.

• Strong analytical and problem-solving abilities.

• Ability to independently manage billing accounts and prioritize A/R follow-ups.

• Strong client relationship and stakeholder management skills.

Preferred Technical Skills

Experience with TriZetto platforms is highly preferred.

Experience with other healthcare clearinghouse and payer platforms such as:

• Waystar
• Availity
• Similar RCM/clearinghouse platforms

Required Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, or a related field.
• Minimum 7 years of relevant experience in US Healthcare Provider-side RCM, with strong exposure to A/R and Denial Management.
• Strong understanding of medical billing, coding, collections, and payer processes.
• Experience working independently on assigned client accounts.
• Excellent communication and interpersonal skills.
• Strong organizational skills and attention to detail.
• Ability to multitask, prioritize workloads, and meet strict deadlines.
• Comfortable working in a remote environment and during US-aligned working hours.

Why Join ModuleMD?

• Work at the intersection of AI, healthcare, and Revenue Cycle Management.
• Opportunity to work with innovative healthcare technology and EHR/Practice Management solutions.
• Work with US healthcare providers and gain exposure to complex RCM operations.
• Join a mission-driven team that values curiosity, autonomy, collaboration, and innovation.
• Remote work environment from India.
• Culture focused on continuous learning and professional growth.