You are responsible for supporting the complete revenue cycle. Your primary focus is ensuring claims are submitted accurately and timely, claim holds are actively worked, outstanding accounts receivable is followed through to resolution, and payment or denial issues are identified and addressed promptly.

You are expected to actively manage assigned billing work rather than simply identify or report issues. Success in this role requires strong attention to detail, consistent follow-through, knowledge of medical billing and payer requirements, and the ability to independently research and resolve claim issues.

You will work closely with the Practice Administrator, providers, clinical staff, front desk staff, and external revenue cycle or payer representatives as needed. This position has no supervisory responsibilities or direct or indirect reports.

Responsibilities:

Claim Submission & Management

Review claims for completeness, coding-related edits, demographic issues, insurance information, required modifiers, and other potential submission errors
Monitor claims-in-hold and claim-edit work queues daily and resolve issues preventing claim submission
Research rejected claims and make necessary corrections for resubmission
Identify recurring claim submission problems and escalate trends to the Practice Administrator
Ensure corrected claims, replacement claims, and other resubmissions are completed accurately and appropriately documented
Monitor claims through the billing cycle to ensure they are successfully accepted and adjudicated

Accounts Receivable

Follow up on unpaid, underpaid, denied, rejected, or otherwise unresolved claims
Prioritize aging accounts and high-dollar balances to prevent unnecessary revenue loss
Contact insurance carriers or use payer portals to determine claim status and identify barriers to payment
Research accounts that have exceeded expected payer processing timelines
Take appropriate corrective action to move outstanding claims toward resolution
Escalate significant or recurring A/R issues to the Practice Administrator
Assist with maintaining A/R within practice-established performance expectations

Denials & Appeals

Review denied claims to determine the reason for denial and appropriate corrective action
Prepare and submit reconsiderations, appeals, supporting documentation, and medical records when required
Monitor submitted appeals and reconsiderations through final resolution
Identify patterns in denials and communicate trends that may require changes to billing, coding, documentation, registration, or clinical workflows
Work collaboratively with providers and staff when additional documentation or clarification is required

Payment & Account Review

Review accounts for payment discrepancies, incorrect adjustments, underpayments, and payer processing errors
Verify that insurance payments and adjustments are consistent with expected reimbursement when appropriate
Research credit balances, unapplied payments, and other account discrepancies as assigned
Coordinate with the appropriate internal or external parties when payment posting corrections are required

Dermatology & Billing Support

Support billing for general dermatology, surgical repairs, biopsies, excisions, destruction procedures, pathology, photodynamic therapy, and other services performed by the practice
Maintain working knowledge of common dermatology and Mohs CPT and ICD-10 coding requirements
Recognize common modifier requirements and billing scenarios associated with dermatology and services
Identify potential bundling, medical necessity, LCD/NCD, authorization, or payer-specific issues affecting
reimbursement
Review billing-related documentation when necessary to support accurate claim submission or appeal activity

Stay current on payer policies and billing requirements that affect the practice

Insurance & Eligibility Issues

Research insurance eligibility, coordination of benefits, authorization, referral, and coverage issues affecting
claims
Work with front desk or clinical staff to obtain missing or corrected insurance information when necessary

Identify registration or insurance-entry errors contributing to claim rejections or denials
Assist with resolving payer-specific requirements that delay or prevent reimbursement

Billing Work Queues & Reporting

Monitor assigned billing work queues consistently and prevent unresolved items from accumulating
Maintain accurate notes documenting billing actions, payer communication, follow-up dates, and account status
Assist with A/R aging reports, denial reports, claim-hold reports, and other revenue cycle reporting as requested
Track outstanding billing issues and ensure appropriate follow-up occurs until resolution
Provide the Practice Administrator with updates on significant billing issues, trends, or revenue concerns
Participate in billing audits and account reviews as requested

Compliance & Documentation

Perform billing activities in accordance with Medicare, Medicaid, commercial payer, and applicable federal and state requirements
Maintain accurate and complete documentation of billing activity
Protect patient financial and health information in accordance with HIPAA and practice policies
Immediately escalate suspected billing, coding, compliance, or reimbursement concerns to the Practice Administrator
Maintain confidentiality of patient, provider, and practice financial information

Qualification:

Required

Prior medical billing, revenue cycle, or insurance claims experience
Working knowledge of medical claims submission and insurance follow-up
Experience researching denied, rejected, unpaid, and underpaid claims
Understanding of CPT, ICD-10, modifiers, and basic medical billing principles
Ability to independently research and resolve billing issues
Strong attention to detail and accuracy
Strong organizational and follow-up skills
Ability to manage multiple billing priorities and work queues simultaneously
Strong written and verbal communication skills
Ability to maintain patient and financial confidentiality

Preferred

Previous dermatology and/or Mohs surgery billing experience
Experience with Medicare and commercial insurance billing
Experience with surgical and procedural billing
Familiarity with LCDs, medical necessity requirements, claim edits, bundling rules, corrected claims, and appeals
Experience using electronic health record and practice management systems
Experience working A/R and denial-management work queues

Schedule: Night Shift

Setup: Remote

Why Join STAFFVIRTUAL?

Competitive compensation and benefits package
HMO Day 1 + FREE dependent coverage
Allowances
Attendance bonus
Paid time offs
Company-provided work setup (laptop, monitor, accessories)
Training, career growth, and global exposure
A collaborative and supportive team culture

If you're a motivated, client-focused professional who's ready to grow with a company that values people and performance, we'd love to hear from you. Apply now and join our dynamic team at STAFFVIRTUAL!

Pay: Php40,000.00 - Php55,000.00 per month

Benefits:

Additional leave
Health insurance
Opportunities for promotion
Work from home

Work Location: Remote

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