[Hiring] Medical Biller & Revenue Cycle Specialist @GoLean Health

Role Description

We are seeking an experienced Medical Biller & Revenue Cycle Specialist to support a nonprofit behavioral health organization in the United States. This is an experienced-level position for someone who can independently oversee and strengthen the clinic's medical billing and revenue cycle processes.

The Medical Biller will:

• Review clinician-entered documentation, billing codes, charge information, and charge slips for completeness and accuracy before claims are processed.
• Identify missing, inconsistent, or potentially incorrect billing information that could affect claim acceptance or reimbursement.
• Coordinate with clinicians or appropriate team members when documentation, coding, or charge information requires correction or clarification.
• Review applicable ICD-10, CPT, HCPCS, and modifier information for consistency with documented services.
• Identify coding or documentation issues that may contribute to claim rejection, denial, underpayment, or compliance concerns.
• Apply strong coding knowledge to validate clinician-entered information while following established clinic and payer requirements.
• Compile and validate patient, provider, payer, diagnosis, procedure, and service information required for claim submission.
• Submit complete claims through AdvancedMD, clearinghouse workflows, or applicable payer processes in a timely manner.
• Monitor submission confirmations and promptly correct claims that are rejected before or during payer processing.
• Monitor submitted claims throughout the payer adjudication process for approval, rejection, denial, underpayment, or other outcomes.
• Review payer responses and determine what action is necessary to move unresolved claims toward payment.
• Maintain accurate documentation of claim status, payer communication, corrective actions, and next steps.
• Research denied or rejected claims to determine root cause and identify the appropriate corrective action.
• Resubmit corrected claims or prepare reconsiderations and appeals with the necessary supporting documentation.
• Track outstanding denials and appeals through resolution while identifying recurring issues that should be prevented in future claims.
• Review and prioritize outstanding Accounts Receivable based on aging, payer, claim status, value, and urgency.
• Follow up directly with insurance companies regarding unpaid, delayed, incorrectly processed, or unresolved claims.
• Monitor timely filing and appeal deadlines to reduce avoidable revenue loss.
• Post insurance payments, contractual adjustments, deductibles, copays, coinsurance, and other applicable amounts accurately.
• Reconcile payments and adjustments against EOBs, ERAs, and available payer information.
• Investigate underpayments, overpayments, posting discrepancies, or unexpected reimbursement differences.
• Review remaining patient responsibility after insurance adjudication and confirm that patient balances are accurate.
• Generate or validate patient statements and support established payment-plan or online payment processes when required.
• Respond professionally to patient billing inquiries and explain account information within the appropriate scope of the role.
• Assist with new provider payer enrollment, credentialing applications, attestations, and required supporting documentation.
• Monitor credentialing applications, payer responses, recredentialing requirements, and expiration dates.
• Follow up with insurance plans regarding pending applications or outstanding enrollment requirements.
• Monitor key revenue-cycle indicators including denial rates, Days in Accounts Receivable, AR aging, outstanding claims, and collection performance.
• Prepare billing and claims status reports and identify payer, denial, reimbursement, or workflow trends requiring attention.
• Communicate significant findings and recommend actions that may improve reimbursement and revenue-cycle performance.
• Conduct internal reviews of billing activity to identify errors, documentation problems, compliance concerns, and workflow gaps.
• Review recurring billing or payer issues that may be contributing to unnecessary denials, delayed payment, or revenue loss.
• Help ensure billing activities follow applicable clinic procedures, payer requirements, HIPAA standards, and healthcare regulations.
• Analyze recurring billing, coding, documentation, AR, and payer issues to identify their underlying causes.
• Recommend workflow improvements that may reduce errors, improve collections, and create more consistent billing performance.
• Proactively bring billing concerns and improvement opportunities to clinic leadership rather than waiting for problems to escalate.
• Document workflows for charge review, claim submission, denials, AR follow-up, appeals, and payment posting.
• Help establish standardized procedures for credentialing, billing reporting, patient balances, and internal audits.
• Update billing SOPs as payer requirements, clinic processes, and operational needs evolve.

Qualifications

• Minimum 2 years of medical billing, revenue cycle management, coding, or closely related US healthcare billing experience.
• Strong understanding of the end-to-end US medical billing lifecycle.
• Strong working knowledge of ICD-10, CPT, and HCPCS coding systems.
• Experience with claim creation and submission.
• Experience managing denied and rejected claims.
• Experience with Accounts Receivable follow-up.
• Experience communicating directly with US insurance companies.
• Understanding of EOBs, ERAs, payment posting, and patient responsibility.
• Experience using medical billing software and EHR systems.
• Ability to independently research and resolve claim issues.
• Strong analytical, organizational, and problem-solving skills.
• Exceptional attention to detail and accuracy.
• Professional written and verbal communication skills.
• Strong HIPAA and healthcare compliance awareness.
• Ability to work independently with limited supervision.
• Reliable and punctual attendance.

Preferred Qualifications

• Previous experience using AdvancedMD.
• Behavioral health or mental health billing experience.
• Medicaid billing experience.
• Provider credentialing and payer enrollment experience.
• Experience creating medical billing SOPs.
• Experience performing revenue-cycle audits.
• Experience analyzing billing KPIs and AR performance.
• Demonstrated experience reducing denials, resolving aged AR, or improving billing workflows.

Systems & Tools

• The primary billing and EHR platform is AdvancedMD.
• The position may also use:
• Insurance payer portals
• Clearinghouse systems
• Microsoft Teams
• Phone services
• Reporting and spreadsheet tools
• VPN and secure remote-access systems
• Time Doctor

Remote Work Requirements

• Dedicated private workspace suitable for confidential healthcare and financial information.
• Reliable computer capable of supporting AdvancedMD and other billing applications.
• Stable primary internet connection.
• Reliable backup internet.
• Verified backup power source.
• Secure and professional remote working environment.
• Strong information-security and HIPAA practices.