Medical Biller

Scale-Up Philippines; Northern (KY); Hybrid; USD 45,000 - 70,000; Full time

Job summary

Scale Up Philippines is partnering with a progressive healthcare organization to hire a skilled Medical Biller with specialized orthopedic billing experience. This role focuses on accurate claims submission and strong revenue cycle operations to support high-quality patient care.

The ideal candidate brings deep expertise in orthopedic billing procedures, payer follow-up, and workers’ compensation claims, ensuring timely reimbursements while maintaining HIPAA compliance in a remote environment.

Qualifications

• Minimum 3 years of medical billing experience with strong orthopedic focus.
• Proven experience with payer follow-up and accounts receivable management.
• Deep knowledge of orthopedic CPT codes, modifiers, and documentation requirements.
• Proficiency with medical billing software and practice management systems.

Responsibilities

• Process and submit medical claims for orthopedic procedures with accuracy.
• Apply CPT, ICD-10, and HCPCS codes for orthopedic services.
• Ensure compliance with payer guidelines (Medicare/Medicaid/commercial).
• Conduct payer follow-up on outstanding claims and resolve denials.
• Manage AR aging and maximize collections.
• Post payments and adjustments in the practice management system.
• Track authorizations and pre-certifications for work comp cases.
• Navigate workers’ compensation billing regulations and requirements.
• Communicate with adjusters, case managers, and TPA’s as needed.
• Reconcile EOBs and ensure proper reimbursement.

Skills

Orthopedic billing experience

Payer follow-up

Accounts receivable management

HIPAA compliance

Attention to detail

Tools

AdvancedMD

Kareo

athenahealth

Job description

Scale Up Philippines is partnering with a progressive healthcare organization to hire a skilled Medical Biller with specialized orthopedic billing experience. This is an excellent opportunity for a detail-oriented billing professional to join a growing practice focused on delivering exceptional patient care while maintaining strong revenue cycle operations.

The ideal candidate brings deep expertise in orthopedic billing procedures, payer follow-up, and workers’ compensation claims. You’ll be a critical member of the revenue cycle team, ensuring accurate claim submissions, timely reimbursements, and compliance with payer requirements.

Key Responsibilities:

Orthopedic Billing & Coding:

• Process and submit medical claims for orthopedic procedures, surgeries, and treatments with accuracy and efficiency
• Apply appropriate CPT, ICD-10, and HCPCS codes specific to orthopedic services
• Ensure compliance with Medicare, Medicaid, and commercial payer guidelines for orthopedic billing

Payer Follow-Up & AR Management:

• Conduct proactive follow-up on outstanding claims with insurance carriers
• Research and resolve claim denials, rejections, and underpayments
• Work aging accounts receivable reports to maximize collections and reduce days in AR
• Appeal denied claims with supporting documentation and medical necessity justification
• Manage the full lifecycle of workers’ comp claims from submission through payment
• Navigate state-specific workers’ compensation billing regulations and requirements
• Communicate effectively with workers’ comp adjusters, case managers, and third-party administrators
• Track authorizations, pre-certifications, and compliance documentation for work comp cases
• Post payments, adjustments, and denials accurately in the practice management system
• Identify and resolve payment discrepancies and coordination of benefits issues
• Reconcile EOBs and ERAs to ensure proper reimbursement

Documentation & Reporting:

• Maintain detailed notes on claim status, payer communications, and resolution actions
• Generate regular reports on collection metrics, denial trends, and AR aging
• Collaborate with clinical and administrative teams to address documentation gaps

Compliance & Quality:

• Stay current on orthopedic billing regulations, payer policy changes, and industry best practices
• Ensure HIPAA compliance in all billing and collection activities
• Participate in internal audits and quality assurance initiatives

Qualifications:

Required Qualifications:

• Minimum 3 years of medical billing experience with strong orthopedic focus (required)
• Proven experience with payer follow-up and accounts receivable management (required)
• Deep knowledge of orthopedic CPT codes, modifiers, and documentation requirements
• Proficiency with medical billing software and practice management systems (e.g., AdvancedMD, Kareo, athenahealth, or similar)
• Strong understanding of insurance verification, authorization processes, and claim adjudication
• Excellent analytical and problem-solving skills with high attention to detail

Preferred Qualifications:

• Certified Professional Biller (CPB) or Certified Medical Reimbursement Specialist (CMRS) certification
• Experience with electronic claims submission and clearinghouse platforms
• Knowledge of Medicare Part B billing and modifier usage for orthopedic services
• Familiarity with IME (Independent Medical Examination) and surgical authorization processes
• Exceptional written and verbal communication in English
• Ability to work independently and manage multiple priorities in a remote environment
• Strong follow-through and persistence in resolving complex billing issues
• Team player with a proactive, solutions-oriented mindset
• High level of integrity and confidentiality when handling sensitive patient information

Why This Role Matters

Orthopedic billing is one of the most complex specialties in medical billing, requiring precision, payer knowledge, and persistence. Your expertise will directly impact the financial health of the practice, allowing clinicians to focus on patient care while you ensure proper reimbursement for the critical services they provide.

Why Join Scale Up Philippines?

At Scale Up Philippines, we connect talented Filipino professionals with world-class clients who value people as much as results. This one is for someone ready to grow.