RCM Specialist

Work Setup: Remote Schedule: 8

working hours
per day + 1-hour unpaid break Job SummaryWe are seeking an experienced Medical Biller with strong skills in reviewing and interpreting U.
S. medical records, processing insurance claims, and verifying medical bills against provider estimates, approved procedures, and final charges. The ideal candidate must understand medical documentation related to MRI, Physical Therapy, Pain Management, PRP Injections, Chiropractic Care, and Shockwave Therapy. A medical-related degree is preferred.

Key Responsibilities
• Request, review, and validate medical bills and records from healthcare providers.
• Interpret clinical notes, diagnoses, imaging reports, treatment plans, and procedure documentation.
• Verify medical bills against provider estimates, approved treatments, and final charges.
• Identify billing discrepancies, coding errors, missing records, and inconsistencies.
• Apply and verify ICD-10-CM, CPT, and HCPCS codes based on medical documentation.
• Prepare, submit, and monitor claims for private insurance, Medicare, and Medicaid.
• Verify insurance eligibility, coverage, benefits, and authorization requirements.
• Investigate denied or rejected claims, make corrections, and resubmit when necessary.
• Post payments and adjustments, follow up on outstanding claims, and prepare billing and accounts receivable reports.
• Communicate with providers and insurers to resolve billing issues while maintaining HIPAA-compliant records. Qualifications
• Experience in U.
S. medical billing, medical coding, claims processing, or Revenue Cycle Management (RCM).
• Strong ability to read and interpret medical records, particularly for the treatments and procedures listed above.
• Knowledge of medical terminology, ICD-10-CM, CPT, and HCPCS codes.
• Understanding of U.
S. healthcare insurance billing, claims processing, and reimbursement.
• Excellent attention to detail, analytical skills, and communication skills.
• Ability to work independently in a remote setup while maintaining accuracy and confidentiality. Preferred: Graduate of a medical-related course.