Medical Billing Specialist (Home-based)

Full Time Employee

Job Summary

Night shift; Hybrid

Job Description

About Us:
Outsourced. ph is a leading ISO-certified Philippines offshore outsourcing company that provides dedicated remote staff to some of the world's leading international companies. Outsourced is recognized as one of the Best Places to Work and has achieved Great Place to Work Certification. We are committed to providing a positive and supportive work environment where all staff can thrive. As an Outsourced staff member, you will enjoy a fun and friendly working environment, competitive salaries, opportunities for growth and development, work-life balance, and the chance to share your passion with a team of over 1,000 talented professionals

Duties and Responsibilities

Accounts Receivable (A/R) Management

• Actively manage assigned insurance A/R buckets to ensure timely follow-up and resolution.
• Investigate and resolve unpaid, underpaid, or denied claims.
• Submit corrected claims and appeals as needed, with strong documentation.
• Submit and track appeals with supporting documentation.
• Resolve coordination of benefits issues and update payer order when needed.
• Handle refund requests and recoupments by documenting and escalating per policies.
• Review aging reports to prioritize high dollar and time sensitive accounts; Identify trends in denials or delays and communicate root causes to leadership.
• Maintain A/R aging targets and productivity benchmarks.
• Maintain accurate, detailed account notes and follow internal workflow for documentation and escalation.

Process & Quality Improvement

• Follow established billing workflows while identifying opportunities to improve efficiency and accuracy.
• Maintain compliance with payer rules, HIPAA, data security, and internal policies.
• Support audits, month-end close activities, and reporting requests as needed.
• Contribute to a culture of accountability, responsiveness, and continuous improvement.

Metric Expectations

• Within 90 Days:
  • Process 30-50 accounts per day including sending updated claims and accurately documenting the chart
  • Maintain 95% accuracy on account work and documentation (rework rate <5% where supervisor or team member must redo)
• By End of First Year:
  • Process a minimum of 60+ accounts per day, including sending updated claims and accurately documenting the chart
  • Can manage full A/R queue for assigned payers with minimal supervision
  • Maintain 98% accuracy or higher on account work and documentation
  • Denials worked within 2 business days with consistent follow up and documentation

Requirements

• College degree preferred but not required
• 2+ years of U.S. medical billing experience required, with primary focus on insurance A/R clean up
• Strong knowledge of full claims cycle
• Ability to read and interpret ERAs/EOBs, denial reasons and remark codes, payer policies and timely filing rules
• Strong knowledge of prior authorization, medical coding, and medical A/R
• Familiarity with payer portals is a plus (Availity, UHC, Aetna, etc.)
• Ability to solve problems and troubleshoot issues, high attention to detail
• Strong written and verbal English communication skills to communicate with internal team members and external payors. Must be able to interpret and manage approval letters, denials, and requests for additional information
• Comfortable making payer calls and communicating professionally with U.S.-based teams.
• Comfortable using multiple browser tabs and portals, pdf tools, Excel
• Track record of maintaining accuracy and organization

Work Location

• Hybrid work set up
• Monday to Friday 11PM-8AM
• Should have strong internet connection (minimum of 20 mbps)
• Should have own Laptop/PC (minimum of i5 8GB RAM)
  

Note: As part of our recruitment process, we conduct a background check on all hired candidates. Please ensure that all required documents are prepared and submitted promptly.