Senior Medical Billing Specialist (Primary Care)

Job Title: Senior Medical Billing Specialist (Primary Care)

Position type: Full-Time

Work hours: 9:00 AM to 6:00 PM Eastern Time

Work days: Monday to Friday

Salary: $7 - $8 per hour

Workplace: Remote

Preferred Candidate Location: Philippines

Our client is a growing U.S.-based healthcare organization dedicated to providing high-quality, patient-centered care. We are seeking a highly experienced, detail-oriented, and results-driven Senior Medical Billing Specialist (Primary Care) to oversee medical billing operations, ensure accurate reimbursement, and lead a team of medical billing associates.

This role combines advanced U.S. primary care medical billing expertise with hands-on team leadership, revenue cycle management, compliance oversight, and process improvement. You will be responsible for ensuring claims are submitted accurately and on time, resolving complex reimbursement issues, maintaining billing procedures, and supporting the professional development of billing associates.

The ideal candidate has at least 3 years of hands-on U.S. medical billing experience, extensive primary care billing knowledge, and proven experience managing or supervising a medical billing team.

You should be confident navigating complex billing processes, applying medical coding knowledge, monitoring payer requirements, and implementing systems that promote accuracy, accountability, and efficiency.

If you're an experienced medical billing professional who enjoys solving complex billing challenges, mentoring team members, and improving revenue cycle performance, we'd love to hear from you!

Key Responsibilities

Primary Care Medical Billing & Claims Management

• Prepare, review, submit, and track medical claims for multiple U.S. primary care providers accurately and within payer filing deadlines.
• Apply advanced knowledge of ICD-10, CPT, HCPCS, and Evaluation & Management (E/M) billing concepts to identify billing errors, coding discrepancies, and documentation gaps.
• Review claims for accuracy, completeness, and compliance with payer-specific requirements.
• Investigate rejected, denied, pending, downcoded, or unpaid claims and oversee corrections, resubmissions, appeals, and follow-ups.
• Identify missed or unfiled claims, aging accounts, and outstanding billing backlogs.
• Prioritize time-sensitive claims and promptly escalate potential reimbursement risks.
• Maintain accurate records of submitted, pending, corrected, and resolved claims.
• Support consistent, timely reimbursement through proactive claims management and follow-up.

Insurance & Revenue Cycle Management

• Verify patient insurance eligibility, coverage, and benefits when needed.
• Communicate with insurance representatives regarding claim status, reimbursement, and payer requirements.
• Oversee accounts receivable (AR), outstanding balances, underpayments, denials, rejections, and payment discrepancies.
• Investigate and resolve downcoding issues, delayed reimbursements, and other revenue cycle concerns.
• Guide payment posting, reconciliation, billing adjustments, and insurance follow-up processes.
• Monitor reimbursement turnaround times and identify opportunities to reduce aging claims.
• Implement process improvements to minimize avoidable denials, reimbursement delays, and revenue loss.
• Stay informed of relevant payer rules, reimbursement guidelines, billing regulations, and policy updates.
• Communicate important payer changes to the billing team and incorporate them into established workflows.

Clinical Documentation, Compliance & Risk Mitigation

• Review billing-related clinical documentation to ensure it supports submitted diagnoses, procedures, and services.
• Identify missing, incomplete, inconsistent, or insufficient documentation that could affect claim accuracy or reimbursement.
• Coordinate with providers and internal staff to resolve documentation discrepancies before claim submission.
• Ensure billing and documentation workflows align with applicable payer requirements and organizational policies.
• Monitor payer policy changes, documentation standards, and relevant regulatory updates.
• Conduct regular documentation reviews, compliance checks, and billing quality assessments.
• Identify potential compliance concerns, document findings, and promptly escalate material risks.
• Promote consistent adherence to HIPAA requirements and patient confidentiality standards.

Billing Team Leadership, Training & SOP Management

• Directly manage, supervise, and support a team of medical billing associates.
• Assign and prioritize billing responsibilities to maintain productivity and timely claims processing.
• Monitor individual and team performance, work quality, and task completion.
• Review actual claim submission statuses, work queues, documentation, and outstanding follow-ups to verify accuracy.
• Provide ongoing coaching, guidance, and constructive feedback to billing associates.
• Develop and maintain standard operating procedures (SOPs) covering claims processing, payer follow-ups, documentation, compliance, and escalation workflows.
• Regularly review and update SOPs to reflect operational improvements and payer requirements.
• Create training materials, onboarding guides, and practical learning resources for current and incoming team members.
• Establish clear performance expectations, accountability checks, and reporting standards.
• Identify knowledge gaps and implement training or process improvements to strengthen team performance.
• Encourage accuracy, transparency, accountability, and continuous improvement across the billing department.

Reporting, Accountability & Operational Support

• Prepare accurate daily progress reports, billing updates, backlog summaries, and outstanding follow-up plans.
• Track claim submission accuracy, unresolved claims, aging accounts, and reimbursement concerns.
• Verify completed work against actual claim statuses and supporting documentation.
• Maintain organized billing records, compliance findings, and departmental performance reports.
• Communicate billing concerns, workflow challenges, and reimbursement risks to management promptly.
• Collaborate with providers, management, and internal staff to improve billing operations.
• Support the development and improvement of in-house billing workflows.
• Assist with healthcare administrative processes, billing documentation, and records management as needed.
• Recommend improvements to billing efficiency, staff development, accountability, and financial performance.
• Adapt to changing operational priorities while maintaining accuracy, compliance, and timely reimbursement.

Top 3 Priorities

1. Primary Care Billing Accuracy & Timely Filing

Ensure accurate and timely claims submission through advanced primary care billing expertise, strong diagnosis and procedure code knowledge, and proactive follow-up. Identify and resolve billing discrepancies before they result in avoidable denials, delayed payments, or lost reimbursement.

2. Payer Compliance & Clinical Documentation Integrity

Monitor payer requirements, regulatory updates, and documentation standards to maintain compliant billing practices. Proactively identify documentation gaps, billing inconsistencies, and potential reimbursement risks while coordinating appropriate resolutions.

3. Team Leadership, SOPs, Training & Accountability

Lead and support medical billing associates, maintain clear and updated SOPs, develop effective training resources, and establish measurable performance expectations. Conduct regular quality checks, verify actual work completion, and improve overall revenue cycle efficiency.

What Success Looks Like

A successful Senior Medical Billing Specialist consistently demonstrates:

• Accurate and timely claims submission across multiple primary care providers.
• Strong oversight of accounts receivable, denials, downcoding issues, and reimbursement follow-ups.
• Proactive identification and resolution of unfiled claims, aging backlogs, and billing discrepancies.
• Consistent compliance with payer requirements and documentation standards.
• Effective leadership, coaching, and performance monitoring of billing associates.
• Clear, updated, and consistently followed departmental SOPs.
• Structured onboarding and training processes for billing team members.
• Accurate and transparent reporting of claims, productivity, and outstanding work.
• Effective communication with providers, insurance representatives, management, and team members.
• Continuous improvements in billing accuracy, operational efficiency, and revenue cycle performance.

Requirements

U.S. Medical Billing & Primary Care Expertise

• At least 3 years of proven, hands-on U.S. medical billing experience (mandatory).
• Extensive experience in U.S. primary care medical billing (mandatory).
• Strong knowledge of primary care diagnoses, medical billing workflows, and reimbursement processes.
• Advanced working knowledge of ICD-10, CPT, HCPCS, and E/M billing guidelines.
• Experience preparing, reviewing, submitting, and tracking electronic medical claims.
• Strong understanding of payer-specific billing requirements and timely filing deadlines.
• Hands-on experience with accounts receivable, denials, rejections, downcoding, insurance appeals, and payer follow-ups.
• Ability to identify billing discrepancies, coding-related claim errors, documentation gaps, and potential reimbursement risks.
• Experience resolving complex claims and reimbursement issues across multiple providers.
• Strong understanding of revenue cycle management and collections processes.

Billing Team Leadership & Management

• Proven experience directly managing, supervising, or leading a team of medical billing associates (mandatory).
• Experience assigning workloads, monitoring productivity, and reviewing billing quality.
• Ability to coach, mentor, and provide constructive feedback to team members.
• Experience creating, maintaining, and updating departmental SOPs.
• Ability to develop training materials, onboarding resources, and staff development processes.
• Experience establishing performance expectations, accountability procedures, and reporting standards.
• Ability to verify actual claims processing activities and completed work.
• Strong leadership, decision-making, and problem-solving skills.
• Ability to manage team performance while maintaining individual accountability and department-wide accuracy.

Clinical Documentation & Compliance Knowledge

• Strong understanding of clinical documentation requirements for primary care billing.
• Ability to assess whether clinical documentation supports billed diagnoses, procedures, and services.
• Familiarity with payer policies, reimbursement requirements, and applicable billing regulations.
• Experience monitoring payer policy changes and implementing updated billing procedures.
• Ability to identify documentation deficiencies and coordinate corrections with providers.
• Knowledge of billing-related compliance checks, risk mitigation, and escalation procedures.
• Strong understanding of HIPAA and patient confidentiality requirements.

Technical & Administrative Skills

• Proficiency with EHR/EMR systems, practice management software, and medical billing platforms.
• Experience using electronic claims submission systems, clearinghouses, and insurance portals.
• Strong proficiency with spreadsheets, claims trackers, billing reports, and productivity monitoring tools.
• Excellent organizational, analytical, and time-management skills.
• Ability to manage multiple priorities and oversee billing operations efficiently.
• Strong attention to detail and accuracy in documentation and reporting.
• Ability to identify workflow inefficiencies and implement practical improvements.
• Comfortable working independently while coordinating with a remote healthcare team.

Communication & Professionalism

• Excellent written and verbal English communication skills.
• Ability to communicate professionally with healthcare providers, insurance representatives, billing associates, and management.
• Strong leadership and interpersonal communication skills.
• Demonstrated reliability, integrity, accountability, and ownership of results.
• Ability to provide accurate, transparent, and timely progress reports.
• Proactive in identifying and escalating concerns.
• Responsive to feedback and committed to continuous improvement.

Preferred Qualifications

• Previous experience as a Senior Medical Billing Specialist, Medical Billing Supervisor, Billing Team Lead, or Revenue Cycle Specialist.
• Experience supporting U.S. family medicine, internal medicine, preventive care, chronic disease management, or multi-provider outpatient practices.
• Strong familiarity with E/M coding guidelines, primary care diagnoses, and outpatient documentation requirements.
• Experience transitioning outsourced billing operations to an in-house billing team.
• Experience establishing or improving billing department workflows.
• Demonstrated success reducing claim denials, resolving AR backlogs, and improving collections.
• Experience training and mentoring medical billing associates.
• Experience developing performance tracking systems and improving revenue cycle metrics.
• Previous experience supporting U.S.-based healthcare organizations remotely.

Ideal Candidate Profile

We're looking for someone who is:

• Highly Experienced: Has extensive hands-on U.S. primary care billing experience and strong knowledge of medical coding and reimbursement processes.
• A Proven Leader: Has successfully supervised billing associates, monitored performance, and supported team development.
• Detail-Oriented: Consistently reviews claims, documentation, and reports for accuracy.
• Proactive: Identifies unfiled claims, denials, downcoding issues, documentation gaps, and compliance risks before they escalate.
• Accountable: Maintains honest, transparent reporting and verifies actual work completion.
• Organized: Effectively manages competing priorities, filing deadlines, and team workloads.
• Process-Driven: Values clear SOPs, structured workflows, and consistent quality standards.
• Analytical: Can investigate complex billing issues and implement effective solutions.
• Collaborative: Communicates effectively with providers, management, and team members.
• Adaptable: Comfortable supporting evolving workflows and operational priorities.
• Compliance-Focused: Prioritizes payer requirements, documentation integrity, HIPAA, and risk mitigation.

Basic Requirements

• Must be proficient in speaking and writing clear, professional English.
• Must have at least 3 years of relevant U.S. medical billing experience, including extensive primary care billing experience.
• Must have previous experience leading or supervising a medical billing team.
• Must be able to submit an NBI Clearance and/or Local Police Clearance before onboarding (mandatory).
• Must be available for video meetings with camera on when required.
• Must be available to work full-time, Monday through Friday, from 9:00 AM to 6:00 PM Eastern Time.

Technical Requirements

• Computer: Reliable laptop or desktop computer.
• Internet: Stable high-speed internet connection (minimum 25 Mbps).
• Audio: Noise-canceling headset.
• Video: Working webcam for virtual meetings.
• Workspace: Quiet and professional work environment.

Benefits

• Dedicated HR & Contractor Support Team: Access to world-class support for questions, guidance, contract matters, and client communication.
• Premium VPN Access (Optional): A secure VPN license can be provided upon request to enhance privacy and security for client-related tasks.
• HIPAA & Cybersecurity Training + Certification (Provided): Access to our internal HIPAA compliance training, cybersecurity modules, and certification to help you confidently handle PHI for U.S. healthcare clients.
• Top 1% VA Performance Training: Access to our proprietary training on communication, client management, productivity systems, and best practices to help you become a top-performing VA and increase long-term client retention.
• Client-Approved U.S. Holidays: Contractors may take U.S. holidays off according to the client’s needs and schedule.
• Client-Approved Paid or Unpaid Time Off: Time off may be granted by your client. Paid time off is optional and only if offered by the client.
• Access to Tools & Resources: Templates, workflow guides, productivity tools, and client-specific SOP support to help you perform at your best.
• Optional Performance-Based Incentives: Some clients may offer bonuses, incentives, or increased hours based on your performance.

These are optional resources and client-approved allowances available to you as an independent contractor. Any resources, training, or allowances listed are optional contractor perks and not employee benefits.

Originally posted on Himalayas