Medical Billing & RCM Specialist

Winning Assistants LLC.; Philippines; Hybrid; PHP 897,122,000 - 1,076,547,000; Full time

Benefits offered by this job

HR & Contractor Support Team

VPN Access (Premium)

HIPAA Training & Certification

VA Performance Training

US Holidays (Client-Approved)

Paid/Unpaid Time Off (Client)

Job summary

Winning Assistants LLC. is seeking a Medical Billing & RCM Specialist to support a U.S.-based healthcare diagnostic practice in a remote, full-time capacity.

The role covers daily billing operations, claims submission, denial resolution, insurance verification, and prior authorizations across platforms like Optum and Office Ally, with HIPAA compliance and strong attention to detail.

Qualifications

• The ideal candidate has strong hands-on experience with U.S. medical billing, claims, denials, unpaid claims, insurance verification, and prior authorizations.
• Experience with remote/VA work is preferred but not required.
• No medical degree or clinical license is required.

Responsibilities

• Manage day-to-day medical billing and Revenue Cycle Management (RCM).
• Prepare, submit, and track medical claims through payment.
• Investigate and resolve claim denials, rejections, and unpaid claims.
• Follow up with insurance companies regarding outstanding claims and reimbursement.
• Perform insurance eligibility and benefits verification.
• Process and track prior authorizations and ensure proper documentation.
• Work extensively with Optum and other billing systems.
• Maintain accurate patient, billing, insurance, referral, and authorization records.
• Use Office Ally and other systems, including insurance portals, clearinghouses, and spreadsheets.
• Maintain clear documentation of billing activities and unresolved issues.
• Communicate professionally with insurance representatives, patients, and healthcare offices as needed.
• Follow SOPs and HIPAA compliance.

Skills

US healthcare experience

Medical Billing & RCM

Claims management

Denials resolution

Insurance verification & prior author.

Office Ally experience

Optum experience

Insurance portals & clearinghouses

US medical billing workflows

Remote/VA experience (preferred)

Tools

Office Ally

Optum

Job description

Job Title: Medical Billing & RCM Specialist
Position Type: Full-Time
Work Hours: 8:00 AM–4:30 PM PDT (30-minute unpaid lunch)
Work Days: Monday–Friday; occasional weekend work may be required as the business grows
Salary: $5–$6/hour, depending on experience
Workplace: Remote
Preferred Candidate Location: Philippines

About the Role

Our client is a growing U.S.-based healthcare diagnostic practice specializing in respiratory, pulmonary, and sleep-related testing. They are looking for an experienced Medical Billing & RCM Specialist who can take ownership of daily billing operations, resolve claim issues, and help maintain a healthy revenue cycle.

The ideal candidate has strong hands-on experience with U.S. medical billing, claims, denials, unpaid claims, insurance verification, and prior authorizations. This role requires someone detail-oriented, organized, proactive, and comfortable working independently across multiple healthcare systems.

Key Responsibilities

• Manage day-to-day medical billing and Revenue Cycle Management (RCM).
• Prepare, submit, and track medical claims through payment.
• Investigate and resolve claim denials, rejections, and unpaid claims.
• Follow up with insurance companies regarding outstanding claims and reimbursement.
• Perform insurance eligibility and benefits verification.
• Process and track prior authorizations and ensure proper documentation.
• Work extensively with Optum, which covers the majority of the practice's patients.
• Maintain accurate patient, billing, insurance, referral, and authorization records.
• Use Office Ally and other systems, including insurance portals, clearinghouses, Square, spreadsheets, and shared drives.
• Maintain clear documentation of billing activities and unresolved issues.
• Communicate professionally with insurance representatives, patients, and healthcare offices as needed.
• Follow established SOPs and workflows while maintaining HIPAA compliance.

• U.S. healthcare experience is required.
• Medical Billing and RCM experience is required.
• Experience handling claims from submission through payment.
• Experience resolving denials, rejections, and unpaid claims.
• Insurance verification and prior authorization experience is required.
• Experience using healthcare billing, EHR, or practice management systems.
• Office Ally experience is highly preferred.
• Optum experience is a strong advantage.
• Experience with insurance portals and clearinghouses.
• Strong understanding of U.S. medical billing and insurance workflows.
• Previous remote/VA experience is preferred but not required.
• No medical degree or clinical license is required.

Skills & Basic Requirements

• Strong attention to detail, organization, and problem-solving skills.
• Ability to manage multiple claims, follow-ups, and deadlines.
• Strong written and verbal English communication skills.
• Professional phone communication skills.
• Ability to work independently and follow detailed SOPs.
• Knowledge of HIPAA compliance; certification is preferred.
• Must provide an NBI Clearance and/or Local Police Clearance before onboarding.
• Must be available for video meetings with the camera on when required.

Technical Requirements

• Computer: Reliable laptop or desktop computer.
• Internet: Stable high-speed internet connection (minimum 25 Mbps).
• Audio: Noise-canceling headset.
• Video: Working webcam for virtual meetings.
• Workspace: Quiet and professional work environment.

• Dedicated HR & Contractor Support Team: Access to world-class support for questions, guidance, contract matters, and client communication.
• Premium VPN Access (Optional): A secure VPN license can be provided upon request to enhance privacy and security for client-related tasks.
• HIPAA & Cybersecurity Training + Certification (Provided): Access to our internal HIPAA compliance training, cybersecurity modules, and certification to help you confidently handle PHI for U.S. healthcare clients.
• Top 1% VA Performance Training: Access to our proprietary training on communication, client management, productivity systems, and best practices to help you become a top-performing VA and increase long-term client retention.
• Client-Approved U.S. Holidays: Contractors may take U.S. holidays off according to the client’s needs and schedule.
• Client-Approved Paid or Unpaid Time Off: Time off may be granted by your client. Paid time off is optional and only if offered by the client.
• Access to Tools & Resources: Templates, workflow guides, productivity tools, and client-specific SOP support to help you perform at your best.
• Optional Performance-Based Incentives: Some clients may offer bonuses, incentives, or increased hours based on your performance.

These are optional resources and client-approved allowances available to you as an independent contractor. Any resources, training, or allowances listed are optional contractor perks and not employee benefits.