Virtual Medical Biller & Revenue Cycle Specialist

We are seeking an experienced, detail-oriented, and analytical Virtual Medical Biller & Revenue Cycle Specialist to take complete ownership of the financial health of a client's growing surgical and aesthetics practice. This role is built for a senior billing professional who understands that specialty surgical billing requires a highly strategic, meticulous approach to maximize reimbursements.

You will manage our revenue cycle from end to end—ensuring complex surgical claims are cleanly coded, submitted swiftly, and aggressively followed through to resolution. The ideal candidate brings a proven track record navigating the distinct nuances of bariatric, general, and cosmetic surgery coding, including mastery over both In-Network (INN) and Out-of-Network (OON) commercial billing models.

Core Responsibilities

Surgical Coding & High-Accuracy Billing (Primary Focus)

• Claim Scrubbing & Submission: Review, scrub, and electronically submit all medical claims timely, ensuring complete compliance with diverse payer policies.
• Specialty Coding Verification: Audit clinical documentation to verify the precise accuracy of complex surgical CPT modifiers, ICD-10 codes, and procedural coding combinations.
• Pre-Submission Quality Control: Proactively catch and resolve technical billing errors prior to clearinghouse submission to maintain an elite first-pass clean claim rate.

End-to-End Revenue Cycle Management (RCM)

• Denial & Appeal Mastery: Actively monitor claim statuses, immediately researching, correcting, and aggressively appealing denied, underpaid, or rejected claims.
• A/R Clean Up: Systematically track insurance aging reports and accounts receivable balances to drastically reduce outstanding days in A/R.
• Performance Analysis: Identify systemic underpayment patterns or friction points with payers, working proactively to streamline workflows and boost overall collections.

Front-End Alignment & Support

• Advanced Benefits Verification: Audit intricate in-network and out-of-network patient insurance profiles, confirming deductibles, coinsurance splits, and specialized surgical caps.
• Authorization & Referral Auditing: Cross-verify that required pre-authorizations and physician referrals are perfectly mapped to the patient's chart and match the scheduled surgical CPT codes.

Payer & Patient Relations

• Insurance Discrepancy Resolution: Maintain assertive, highly professional communication with commercial insurance carriers and Medicare to resolve complex claim bottlenecks.
• Financial Counseling Support: Clearly and compassionately explain billing statements, insurance allocations, and balances to patients when escalated billing inquiries arise.

Requirements

Required Qualifications (Non-Negotiable)

• Biller Credentials: Minimum 2+ years of dedicated U.S. medical billing experience, with a heavy emphasis on full-cycle revenue management.

• Surgical Billing Acumen: Proven experience working inside a surgical or specialty medical practice; comfortable with multi-tier surgical coding rules.
• Insurance Ecosystem Fluency: Deep understanding of the operational differences between In-Network and Out-of-Network insurance models, commercial payers, and Medicare.
• Technical Workspace: Dedicated, highly secure home office setup compliant with HIPAA privacy protocols, equipped with high-speed internet and a dual-monitor environment (preferred).

Strongly Preferred Experience

• Direct, hands-on billing experience for Bariatric Surgery, General Surgery, or Medical Aesthetics.
• Advanced technical fluency within the Practice Fusion EMR ecosystem.
• Deep knowledge of surgical bundling, multiple procedure modifiers (e.g., Modifier 51, 59), and assistant surgeon billing.