Job Title: Billing Representative (Remote)
Job Overview:
You are responsible for supporting the complete revenue cycle. Your primary focus is ensuring claims are submitted accurately and timely, claim holds are actively worked, outstanding accounts receivable is followed through to resolution, and payment or denial issues are identified and addressed promptly.
You are expected to actively manage assigned billing work rather than simply identify or report issues. Success in this role requires strong attention to detail, consistent follow-through, knowledge of medical billing and payer requirements, and the ability to independently research and resolve claim issues.
You will work closely with the Practice Administrator, providers, clinical staff, front desk staff, and external revenue cycle or payer representatives as needed. This position has no supervisory responsibilities or direct or indirect reports.
Responsibilities:
Claim Submission & Management
- Review claims for completeness, coding-related edits, demographic issues, insurance information, required modifiers, and other potential submission errors
- Monitor claims-in-hold and claim-edit work queues daily and resolve issues preventing claim submission
- Research rejected claims and make necessary corrections for resubmission
- Identify recurring claim submission problems and escalate trends to the Practice Administrator
- Ensure corrected claims, replacement claims, and other resubmissions are completed accurately and appropriately documented
- Monitor claims through the billing cycle to ensure they are successfully accepted and adjudicated
Accounts Receivable
- Follow up on unpaid, underpaid, denied, rejected, or otherwise unresolved claims
- Prioritize aging accounts and high-dollar balances to prevent unnecessary revenue loss
- Contact insurance carriers or use payer portals to determine claim status and identify barriers to payment
- Research accounts that have exceeded expected payer processing timelines
- Take appropriate corrective action to move outstanding claims toward resolution
- Escalate significant or recurring A/R issues to the Practice Administrator
- Assist with maintaining A/R within practice-established performance expectations
Denials & Appeals
- Review denied claims to determine the reason for denial and appropriate corrective action
- Prepare and submit reconsiderations, appeals, supporting documentation, and medical records when required
- Monitor submitted appeals and reconsiderations through final resolution
- Identify patterns in denials and communicate trends that may require changes to billing, coding, documentation, registration, or clinical workflows
- Work collaboratively with providers and staff when additional documentation or clarification is required
Payment & Account Review
- Review accounts for payment discrepancies, incorrect adjustments, underpayments, and payer processing errors
- Verify that insurance payments and adjustments are consistent with expected reimbursement when appropriate
- Research credit balances, unapplied payments, and other account discrepancies as assigned
- Coordinate with the appropriate internal or external parties when payment posting corrections are required
Dermatology & Billing Support
- Support billing for general dermatology, surgical repairs, biopsies, excisions, destruction procedures, pathology, photodynamic therapy, and other services performed by the practice
- Maintain working knowledge of common dermatology and Mohs CPT and ICD-10 coding requirements
- Recognize common modifier requirements and billing scenarios associated with dermatology and services
- Identify potential bundling, medical necessity, LCD/NCD, authorization, or payer-specific issues affecting
reimbursement - Review billing-related documentation when necessary to support accurate claim submission or appeal activity
- Stay current on payer policies and billing requirements that affect the practice
Insurance & Eligibility Issues
- Research insurance eligibility, coordination of benefits, authorization, referral, and coverage issues affecting
claims - Work with front desk or clinical staff to obtain missing or corrected insurance information when necessary
- Identify registration or insurance-entry errors contributing to claim rejections or denials
- Assist with resolving payer-specific requirements that delay or prevent reimbursement
Billing Work Queues & Reporting
- Monitor assigned billing work queues consistently and prevent unresolved items from accumulating
- Maintain accurate notes documenting billing actions, payer communication, follow-up dates, and account status
- Assist with A/R aging reports, denial reports, claim-hold reports, and other revenue cycle reporting as requested
- Track outstanding billing issues and ensure appropriate follow-up occurs until resolution
- Provide the Practice Administrator with updates on significant billing issues, trends, or revenue concerns
- Participate in billing audits and account reviews as requested
Compliance & Documentation
- Perform billing activities in accordance with Medicare, Medicaid, commercial payer, and applicable federal and state requirements
- Maintain accurate and complete documentation of billing activity
- Protect patient financial and health information in accordance with HIPAA and practice policies
- Immediately escalate suspected billing, coding, compliance, or reimbursement concerns to the Practice Administrator
- Maintain confidentiality of patient, provider, and practice financial information
Qualification:
Required
- Prior medical billing, revenue cycle, or insurance claims experience
- Working knowledge of medical claims submission and insurance follow-up
- Experience researching denied, rejected, unpaid, and underpaid claims
- Understanding of CPT, ICD-10, modifiers, and basic medical billing principles
- Ability to independently research and resolve billing issues
- Strong attention to detail and accuracy
- Strong organizational and follow-up skills
- Ability to manage multiple billing priorities and work queues simultaneously
- Strong written and verbal communication skills
- Ability to maintain patient and financial confidentiality
Preferred
- Previous dermatology and/or Mohs surgery billing experience
- Experience with Medicare and commercial insurance billing
- Experience with surgical and procedural billing
- Familiarity with LCDs, medical necessity requirements, claim edits, bundling rules, corrected claims, and appeals
- Experience using electronic health record and practice management systems
- Experience working A/R and denial-management work queues
Schedule: Night Shift
Setup: Remote
Why Join STAFFVIRTUAL?
- Competitive compensation and benefits package
- HMO Day 1 + FREE dependent coverage
- Allowances
- Attendance bonus
- Paid time offs
- Company-provided work setup (laptop, monitor, accessories)
- Training, career growth, and global exposure
- A collaborative and supportive team culture
If you're a motivated, client-focused professional who's ready to grow with a company that values people and performance, we'd love to hear from you. Apply now and join our dynamic team at STAFFVIRTUAL!
