Medical Biller and RCM Specialist

Location: Philippines We are seeking an experienced, detail-oriented, and highly analytical Medical Biller and RCM Specialist to support a busy mental health clinic led by Dr. Mann. In this critical revenue-recovery role, you will initially oversee and audit the output of an external, third-party medical billing company whose contract runs through April 2027. With approximately 90 days of pending billing and 500+ outstanding patient encounters, your mission is to identify claim bottlenecks, resolve billing errors, hold the external agency accountable, and directly recapture revenue for the practice. The ideal candidate possesses 3+ years of U.S. medical billing and coding experience , specialized background in mental/behavioral health billing , and strong familiarity with California payer landscapes, Medi-Cal, and complex state compliance regulations. This position starts as a part-time role (~20 hours/week) for the first month with a direct path to full-time employment as you take over full in-house billing operations. Working Environment & Core Schedule Role Title: Virtual Medical Billing Specialist & Revenue Oversight Lead Specialty: Mental Health / Behavioral Health Clinic Status: Part-Time (~20 Hours / Week for Month 1) transitioning to Full-Time based on revenue recovery and operational demand Schedule: Flexible 4–5 hours per day within Monday – Friday, 10:00 AM – 7:00 PM PST (Pacific Standard Time) Core Technology Stack: OnlyMD EMR & Billing System , Practice VoIP System, Dedicated Company Email Domain Primary Objective: Revenue recovery, clearing a 500+ encounter backlog, external billing agency audit, and claim resolution Top 3 Daily Tasks External Billing Agency Audit & Monitoring: Review daily submissions from the current third-party billing company, cross-referencing OnlyMD EMR encounters against filed claims to uncover unbilled encounters, coding errors, and dropped tasks. Backlog Clearance & Outstanding Claim Follow-Up: Investigate approximately 90 days of pending billing and 500+ unsubmitted encounters; communicate directly with payors and the billing agency to resolve rejections and denials. Billing List & Patient Account Management: Maintain organized billing tracking logs in OnlyMD, resolve patient insurance eligibility discrepancies, and provide Dr. Mann with transparent weekly AR recovery reports. Core Responsibilities Third-Party Agency Oversight: Serve as the practice’s internal watchdog—auditing the external vendor's work, tracking claim transmission cadences, and flagging systematic errors or delays. Mental Health Billing & Coding Audit: Ensure accurate CPT/ICD-10 coding for behavioral health encounters, therapy sessions, and psychiatric evaluations within OnlyMD. Claims Tracking & Denial Management: Identify root causes for unpaid, rejected, or unsubmitted claims; execute corrective actions, appeals, and resubmissions. Payor & Regulatory Compliance: Navigate complex California state medical billing regulations, county/state-specific paperwork, and commercial/government payor guidelines to streamline credentialing and reimbursement. Full In-House Transition Preparation: Document billing workflows and prepare the practice to seamlessly bring 100% of billing operations in-house when the third-party contract concludes. Requirements 3+ Years Medical Billing & Coding Experience: Proven track record in AR follow-up, claims auditing, denial management, and medical revenue cycle management (RCM). Mental/Behavioral Health Specialty Background: Direct experience with mental health billing, psychiatric CPT codes, pre-authorizations, and behavioral health payor rules. California State & Payer Familiarity: Proven capacity to master complex state-specific billing rules, California payor guidelines, and local paperwork/credentialing requirements. Auditing & Agency Management Skills: Demonstrated experience auditing external billing vendors, tracking down missing encounters, and holding teams accountable to billing metrics. Schedule Flexibility: Ability to work part-time (~20 hrs/week) across a flexible schedule within 10:00 AM – 7:00 PM PST , with full availability to transition to 40 hrs/week full-time. Remote Workspace Setup: Dedicated, private, quiet HIPAA-compliant home office equipped with a high-performance computer (PC/Mac), high-speed internet connection, backup internet/power solutions, and a headset. Preferred Qualifications Hands-on experience navigating OnlyMD EMR & Billing System (or comparable integrated EMR/billing systems). Experience transitioning a clinic from an outsourced billing agency to an in-house billing structure. Ideal Candidate Profile You are a sharp, tenacious medical billing specialist who thrives on solving financial puzzles. You know how to audit an external billing company's work, track down unbilled encounters, untangle complex California mental health claims, and bring cash flow back into the clinic while building an efficient in-house billing system.