Medical Biller

Job Description: GoTo Telemed seeks an exceptional Remote Medical Biller to manage comprehensive Revenue Cycle Management (RCM) operations for our rapidly expanding telehealth platform serving multiple medical specialties and healthcare providers nationwide. As a key member of our distributed RCM team, you will process, manage, and optimize medical claims for an increasing portfolio of telehealth providers—with new clients and provider networks added every month as our organization scales. In this critical role, you will be the financial backbone of our provider network, managing the complete end-to-end billing lifecycle including patient eligibility verification, insurance claim submission, payment posting, accounts receivable follow-up, and comprehensive denial management. Your expertise in medical coding (CPT, ICD-10-CM, HCPCS), telehealth modifiers, payer policies, and compliance will directly impact provider revenue, patient satisfaction, and our organizational growth trajectory. This position offers exceptional opportunity for professional growth, career advancement, and organizational scaling as GoTo Telemed expands its provider network and service offerings monthly. You will receive comprehensive training, access to cutting-edge RCM tools and resources, and mentorship to develop into a senior RCM specialist or team lead. Why Join GoTo TelemedUnlimited Growth OpportunityMonthly Provider & Client Expansion: As GoTo Telemed adds new healthcare providers and medical specialties every month, your responsibilities and earning potential expand proportionallyScalability without Chaos: We implement systematic processes, training, and resources to ensure smooth scaling—you grow professionally without being overwhelmedCareer Advancement Path: Progress from Medical Biller → Senior Biller → RCM Team Lead → RCM Manager → Director of Revenue OperationsSkill Diversification: Work with multiple medical specialties (primary care, cardiology, orthopedics, behavioral health, urgent care, etc.), expanding your coding and compliance expertiseComprehensive Support & ResourcesProfessional Training Programs: Formal onboarding, continuous education on CPT/ICD-10 updates, telehealth policy changes, and payer-specific requirementsCertification Support: Full reimbursement for CPB, CPC, CCA, or other healthcare credentials; study time and exam fees coveredAdvanced RCM Technology: Access to best-in-class practice management systems, claims clearinghouses, coding software, and automation toolsExpert Mentorship: Paired with experienced RCM professionals for guidance on complex coding scenarios, denial resolution, and process optimizationPeer Collaboration: Work with a talented distributed team of medical billers, coders, and RCM specialists—regular team meetings, knowledge sharing, and collaborative problem-solvingRemote Work Flexibility100% Work-from-Home: Eliminate commuting; work from anywhere with reliable internetFlexible Schedule: Core hours 8 AM – 5 PM CST, with flexibility for medical appointments, personal needs, and work-life balanceHome Office Support: $500 annual stipend for home office equipment, internet upgrades, and ergonomic setupDistributed Team Culture: Collaborate with colleagues across time zones; async communication tools support flexible schedulingFinancial Rewards & GrowthPerformance-Based Incentives: Earn bonuses based on claims processed, approval rates, AR reduction, and denial prevention—your accuracy and efficiency directly increase earningsAnnual Raises & Reviews: Merit-based salary increases tied to performance, certifications, and expanded responsibilitiesUnlimited Earning Potential: As the provider network grows, so do opportunities for higher-volume processing, team oversight, and management roles with corresponding salary increasesTransparent Compensation: Clear performance metrics and bonus structure; you always know how to increase earnings Primary ResponsibilitiesInsurance Eligibility & VerificationVerify patient medical insurance eligibility and benefits prior to telehealth appointment scheduling using secure insurance verification portals and phone verificationConfirm coverage details including deductibles, out-of-pocket maximums, copays, coinsurance, frequency limitations, and telehealth coverage statusIdentify medical necessity requirements, pre-authorization, and referral requirements; obtain all necessary approvals before service deliveryMaintain accurate, current insurance information in practice management systems; update policies when changes occurIdentify coverage gaps, exclusions (telehealth limitations, specialty exclusions, etc.), and conditions affecting billing and collectionsDocument all verification activities and flag special requirements or coverage concerns for clinical and billing teamsPatient Registration & DemographicsEnsure complete, accurate patient demographic and insurance data capture at appointment bookingValidate patient information accuracy (name, date of birth, insurance policy numbers, group numbers, member IDs, etc.)Update patient records when insurance changes, policies renew, or coverage terminations occurCommunicate patient financial responsibilities, copays, deductibles, and projected out-of-pocket costs before service deliveryCapture patient consent for services and billing; document in compliance with HIPAA and state telehealth regulationsMedical Coding & Claims PreparationAccurately code telehealth visits and medical services using Current Procedural Terminology (CPT) codes and appropriate modifiersAssign correct ICD-10-CM codes for all diagnoses documented in clinical notesApply telehealth-specific modifiers (93 for audio-only, 95 for audio/video synchronous, GT, FQ, FR) in accordance with payer policies and CMS guidanceVerify correct place of service (POS) coding for telehealth encounters (POS 02 for provider office, POS 10 for patient home, POS 11 for patient location as specified)Ensure complete charge capture and accurate medical necessity documentation; identify any missing information before claim submissionReview clinical documentation for specificity (laterality, severity, complexity) and communicate coding queries to providers when documentation is insufficientStay current with annual CPT/ICD-10 updates, new telehealth codes (98000-series), and payer-specific coding requirementsClaims Submission & ManagementSubmit medical claims electronically through clearinghouses (837 EDI format) within 3-5 days of service deliveryPrepare and manage claims via multiple submission pathways: electronic clearinghouse, direct payer portals, and print-to-mail for specific payers or situationsTrack all submitted claims with documentation of submission date, claim number, claim status, and clearinghouse identificationMonitor claim status continuously; flag claims at risk of denial or delay for proactive follow-upManage front-end claim edits and rejections; correct claim errors and resubmit within 24 hoursComply with all payer-specific requirements: claim format, documentation attachments, modifier usage, and submission deadlinesMaintain detailed claim tracking logs for audit and reporting purposesAccounts Receivable (AR) Follow-Up & CollectionsMonitor outstanding claims daily; conduct systematic follow-up on all claims past 15, 30, 45, and 60 daysContact insurance companies via phone, email, and secure payer portals to obtain claim status, identify delay reasons, and resolve pending issuesReview Explanations of Benefits (EOBs) and identify payment discrepancies, underpayments, or improper adjustmentsSend timely patient statements weekly for patient responsibility balances exceeding 30 daysFollow up on patient balances through professional phone calls, patient statements, and secure messagingImplement systematic collection procedures for patient accounts 30 days past dueNegotiate payment plans and settlements with patients while maintaining professional, ethical communicationDocument all collection activities, patient communications, and payment arrangements in patient recordsMaintain compliance with Fair Debt Collection Practices Act (FDCPA) and state collection lawsClaims Denial Management & AppealsAnalyze all claim denials and rejections; identify root causes (coding errors, missing documentation, eligibility issues, medical necessity, prior authorization gaps, etc.)Prepare corrected claims with necessary documentation changes; resubmit per payer guidelinesPrepare formal written appeals for denied claims with supporting clinical documentation and policy justificationTrack appeal submissions and responses; resubmit appeals as needed until resolutionCalculate impact of denials on provider revenue; prioritize high-value or recurring denials for focused remediationMaintain denial tracking reports to identify patterns by payer, code, diagnosis, or providerImplement process improvements to prevent recurrence of common denial reasonsIdentify underpayments and contractual adjustment errors; prepare documentation for recovery or credit adjustmentPayment Posting & ReconciliationPost insurance payments and Explanations of Benefits (EOBs) to patient accounts accurately and timelyReconcile posted EOBs with submitted claims and identify discrepancies, missing payments, or claim-to-claim variationPost patient payments from multiple sources: patient payments, payment plans, refund processingApply payments to correct patient accounts and claim lines; maintain clear audit trail for all transactionsProcess contractual adjustments and write-offs per payer fee schedules and provider agreementsReconcile monthly insurance payments and EOBs with banking records; reconcile provider revenue reportsIdentify and resolve payment discrepancies, missing EOBs, and payment delays within 5 business daysPrint-to-Mail OperationsIdentify claims, appeals, and patient statements requiring physical mail delivery per payer requirementsPrepare documentation for printing and mailing; ensure compliance with HIPAA Privacy Rule requirementsMaintain print-to-mail logs with tracking information and addressesVerify patient and provider mailing addresses; ensure HIPAA-compliant deliveryTrack delivery of critical documents using postal tracking when available and appropriateReporting & AnalyticsGenerate daily claim processing reports (claims submitted, claims pending, claims approved)Produce weekly and monthly revenue cycle reports including:Days in Accounts Receivable (DAR) by payerClaim submission volume and claim approval ratesDenial rates, denial reasons, and denial trendsPatient collection rates and aging AR analysisPayment posting timeliness and payment discrepanciesClean claim rates (first-pass acceptance)Identify trends and process improvement opportunities; communicate findings to managementTrack Key Performance Indicators (KPIs) and compare performance against industry benchmarksSupport management reporting and financial forecasting RequirementsCompliance & DocumentationMaintain strict adherence to HIPAA Privacy Rule, Security Rule, and Breach Notification RuleEnsure all patient communications comply with state-specific telehealth patient rights and privacy requirementsFollow OIG compliance program guidelines including periodic HHS OIG LEIE database checksComply with Anti-Kickback Statute (AKS), Stark Law, and False Claims Act requirements in all billing activitiesDocument all billing activities, communications, and decisions in patient records for audit readinessMaintain confidentiality of patient Protected Health Information (PHI) at all timesReport potential compliance concerns through established compliance and ethics channelsParticipate in compliance training annually and whenever policies are updatedMulti-Specialty & Multi-Payer ExperienceManage claims across multiple medical specialties and service types as GoTo Telemed expands its provider networkLearn specialty-specific coding requirements (behavioral health, primary care, specialty visits, behavioral health, etc.)Adapt to evolving payer policies and coverage decisions as new providers and payers are added monthlyShare knowledge with new team members as the RCM team scalesSupport training of new medical billers joining the team Required Qualifications & SkillsEducation & CertificationHigh school diploma or GED requiredFormal training in medical billing, medical coding, healthcare administration, or related field requiredCurrent or willingness to obtain medical billing certifications within 12 months:Certified Professional Biller (CPB) through AAPC (preferred)Certified Professional Coder (CPC) through AAPC (preferred)Certified Coding Associate (CCA) through AAPCCertified Healthcare Billing and Management Executive (CHBME)Comprehensive, current knowledge of:CPT codes and medical coding principlesICD-10-CM diagnostic codingHCPCS Level II codesTelehealth-specific modifiers (93, 95, GT, FQ, FR)Medical terminology and anatomy.Professional ExperienceDemonstrated telehealth/telemedicine billing experience strongly preferredHands-on experience with insurance verification and patient eligibility determinationProfessional experience with medical claims submission (electronic and paper)Direct accounts receivable follow-up and patient collections experienceDenial management and claims appeal experienceEOB/ERA reconciliation and payment posting experienceExperience with multiple medical specialties (primary care, urgent care, specialty practices, etc.) preferredExperience with multi-state provider networks and varying payer policies preferredTechnical Skills & Software ProficiencyAdvanced proficiency with Microsoft Office Suite (Excel, Word, Outlook)Hands-on experience with medical billing software and practice management systems (eClinicalWorks, Athenahealth, Kareo, NextGen, Medidata, or similar platforms)Proficiency with electronic health record (EHR) systems common to telehealth environmentsExperience with insurance company portals, claim submission systems, and clearinghouses (Availity, Change Healthcare, Emdeon, NTPC)Strong data entry, spreadsheet, and database management skillsFamiliarity with medical coding software and/or encoder systems (OptumInsight, Codebook, Pathways, etc.)Ability to navigate multiple software platforms simultaneously and switch between systems efficientlyComfort learning new software and platforms quickly as organizational tools evolveCompliance & Regulatory KnowledgeComprehensive understanding of HIPAA Privacy Rule, Security Rule, and Breach Notification RuleWorking knowledge of OIG Anti-Kickback Statute, Stark Law, and exclusion list complianceUnderstanding of CMS Medicare policies, modifiers, and reimbursement methodologies for telehealthKnowledge of state-specific telehealth regulations and billing requirements (particularly states where GoTo Telemed operates)Familiarity with medical necessity and coverage determination processesUnderstanding of CPT coding standards, payer-specific coding guidelines, and LCD/NCD policiesKnowle

Salary : $500