US Medical Billing Specialist

Virtual Innovations; Metro Manila; On-site; PHP 207,000 - 482,000; Full time

Job summary

Virtual Innovations is seeking an insurance revenue cycle specialist to support back-office claims processing. The role focuses on insurance discovery, eligibility verification, and secondary payer follow-up using AdvancedMD and payer portals.

You will handle EOB interpretation, COB rules, and communication with commercial and government payers to optimize reimbursements while maintaining strict PHI privacy and compliance standards.

Qualifications

• 1–3 years of US medical billing experience or revenue cycle background.
• Hands-on experience with AdvancedMD (PM/RCM) modules preferred.
• Strong understanding of COB rules, EOB interpretation, and payer rejections.
• Familiar with CPT/ICD-10 coding and claim modifiers.
• Proficient using major insurance portals and payer research tools.
• Maintains HIPAA compliance and protects PHI.

Responsibilities

• Perform proactive insurance discovery to identify active primary and secondary coverage for unbilled or demographic-rejected claims.
• Verify coverage dates, benefit caps, copays, deductibles, and authorization requirements using payer portals and clearinghouses.
• Update patient billing files in AdvancedMD to ensure clean claim submission on initial runs.
• Manage secondary insurance billing after primary adjudication (EOB/ERA review).
• Contact payers via phone and portals to resolve outstanding 2nd-party balances.
• Re-file claims with proper COB details and billing modifiers.
• Identify and correct billing errors or payer rejections preventing secondary payment.
• Use AdvancedMD daily to work aging reports, worklists, and claim hold queues.
• Document precise AR notes regarding payer status and timelines.
• Collaborate with pathology coding/billing team to resolve systemic blockers.

Skills

US Billing

AdvancedMD

COB

EOB Review

CPT/ICD-10

Payor Portals

HIPAA

Tools

Availity Portal

NaviNet

Job description

About the role

This is a specialized back-office revenue cycle support role focused on maximizing claim reimbursement through accurate insurance discovery, eligibility verification, and secondary payer claim follow-up. This is a non-patient-facing position ideal for candidates who excel at insurance research, portal navigation, payer outreach, and revenue cycle problem-solving using AdvancedMD software.

Key responsibilities

• Perform proactive insurance discovery to identify active primary and secondary coverage for unbilled or demographic-rejected claims

• Verify coverage dates, benefit caps, copays, deductibles, and authorization requirements using online payer portals, batch eligibility clearinghouses, and direct line inquiries

• Update patient billing files and demographics in AdvancedMD to ensure clean claim submission on initial billing runs

• Manage and process secondary insurance billing following primary adjudication (EOB/ERA review)

• Contact commercial, Medicare, Medicaid, and supplemental insurance payers via telephone and web portals to resolve outstanding 2nd-party balances

• Re-file claims with proper primary EOB attachments, coordination of benefits (COB) details, and appropriate billing modifiers

• Identify and correct billing errors or payer rejections preventing secondary payment

• Utilize AdvancedMD daily to work assigned aging reports, worklists, and claim hold queues efficiently

• Document precise, professional accounts receivable notes regarding payer status, claim refilings, and expected resolution timelines

• Collaborate with internal pathology coding and billing team members to resolve systemic billing blockers

About you

• At least 1–3 years of US Medical Billing experience, revenue cycle management, or insurance claims processing (pathology or lab billing experience is a strong plus)

• Minimum 1 year of hands-on experience using AdvancedMD (PM/RCM modules) preferred

• Strong understanding of COB (Coordination of Benefits), primary vs. secondary payer rules, EOB interpretation, CPT/ICD-10 codes, and clearinghouse rejections

• Proficiency with major insurance portals (Availity, NaviNet, Medicare/Medicaid portals) and web-based research tools

• Exceptional attention to detail, strong analytical skills, and efficient phone etiquette when navigating insurance payer call trees

• Maintain complete compliance with HIPAA rules and regulations, maintaining strict confidentiality over all Protected Health Information (PHI)