Medical Specialist Hospital jobs

Spillway Workforce Solutions is a remote staffing and business solutions company with clients in the United States and the United Kingdom.

We are seeking an experienced Hospital Revenue Cycle Management (RCM) Medical Biller with a minimum of 10+ years of dedicated billing and coding experience, specifically within Physical Medicine and Rehabilitation (PM&R). The ideal candidate will possess deep expertise in navigating complex hospital billing ecosystems, handling institutional (837I) and professional (837P) claims, and managing specialty-specific clinical documentation, modifier usage, and payer guidelines.

Key Responsibilities

• Specialty Billing & Coding (PM&R): Accurately review, code, and process medical claims for inpatient and outpatient PM&R services, ensuring strict compliance with ICD-10-CM, CPT/HCPCS, and NCCI edit guidelines.
• Complex Modifier Management: Expertly apply and audit specialty-specific modifiers (such as Modifier 25 and Modifier 59) to prevent diagnostic and preventative care conflicts on same-day evaluation and management visits.
• Clearinghouse & Claim Scrubbing: Utilize advanced clearinghouse platforms (e.g., Waystar, Change Healthcare, Availity) to resolve claim edit rejections, format EDI 837/835 transactions, and ensure high first-pass clean claim rates.
• Denial Management & Root-Cause Analysis: Systematically investigate claim rejections, execute structured appeal workflows within contractual timely filing limits, and participate in cross-functional feedback loops to eliminate recurring billing errors.
• AR & Revenue Optimization: Monitor and manage accounts receivable (AR) aging reports, track electronic remittance advice (ERA 835) auto-postings, and support expedited revenue realization.

Qualifications & Requirements

• Experience: Minimum of 10+ years of revenue cycle management experience within hospital billing, with specialized expertise in Physical Medicine and Rehabilitation (PM&R)
• Active professional coding or billing certification (e.g., CPC, RHIT, CHRI) is strongly preferred.
• Hands-on experience working within major Electronic Health Record (EHR) and Practice Management systems (such as Epic Resolute, Oracle Health/Cerner, Athenahealth, or eClinicalWorks).
• Comprehensive understanding of Medicare, Medicaid, and commercial payer guidelines, as well as HIPAA compliance protocols for hospital RCM operations.
• Proven track record of lowering claim denial rates, reducing charge capture lag, and maintaining high clean-claim submission benchmarks.

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Pay: Php50,000.00 - Php75,000.00 per month

Benefits:

• Work from home

Application Question(s):

• Do you have prior experience handling Physical Medicine & Rehabilitation (PM&R) billing?
• What electronic health record and practice management systems have you used?
• Do you have an active coding or billing certificate?

Experience:

• Hospital billing: 10 years (Preferred)
• Revenue cycle management: 10 years (Preferred)

Work Location: Remote