Medical Billing Specialist

Phothera Phototherapy; Columbia (SC); Híbrido; USD 39 000 - 44 000; Tempo integral

Resumo da oferta

Phothera Phototherapy is seeking a Medical Billing & Follow-Up Specialist to join the Revenue Cycle team. This individual contributor role focuses on AR follow-up, denial management, and strategic payer interactions to improve cash flow.

The position supports a growing in-home phototherapy provider transitioning to a new RCM platform. Office or remote work arrangements are available as the company scales operations and optimizes processes.

Qualificações

• 2+ years of experience in medical billing and revenue cycle management.
• Experience with CMS-1500 claims for professional billing.
• Experience investigating unpaid/denied claims and payer follow-up.
• Strong understanding of EOBs/ERAs and claim corrections.
• Experience with Medicare/Medicaid and commercial payers.
• Knowledge of CPT/HCPCS modifiers and medical necessity requirements.
• Ability to research issues and determine next steps.
• Excellent organizational skills for high-volume claims.
• Ability to work independently in a remote environment.

Responsabilidades

• Track and resolve unpaid, underpaid, or delayed DME claims
• Submit and follow up on Medicare, Medicaid, Commercial, and VA claims
• Interpret EOBs and ERAs and apply payments accurately
• Research payer policies, LCDs and NCDs, and coverage requirements
• Validate documentation including CMNs, prescriptions, proof of delivery, and prior authorizations
• Submit appeals when necessary and monitor outcomes
• Identify systemic issues and recommend process improvements
• Maintain detailed, compliant documentation within the billing system

Conhecimentos

Medical billing

CMS-1500 claims

Denial management

Payer follow-up

Medicare/Medicaid/Commercial payers

CPT/HCPCS knowledge

Root-cause analysis

Organization

Remote work

Descrição da oferta de emprego

Work Arrangement: Office or remote

Reports to: Revenue Cycle Manager

Role Type: Individual Contributor

Compensation: $28.00 - $32.00 per hour

FLSA Classification: Non-Exempt

Lucas James Talent Partners is partnering with Phothera, a Madison Industries company, to identify a driven and proactive Medical Billing & Follow-Up Specialist to join their growing Revenue Cycle team.

Phothera provides innovative in-home phototherapy solutions that help patients safely manage autoimmune skin conditions such as Psoriasis, Atopic Dermatitis, and Vitiligo. As the organization scales rapidly, they are investing in strengthening their revenue cycle infrastructure, including implementing a new RCM platform and building focused work queues to support a high-performing billing team.

This is an opportunity to join during a pivotal growth phase and play a meaningful role in improving processes, accelerating cash flow, and driving operational excellence.

The Opportunity

This position is focused heavily on accounts receivable follow-up and resolving unpaid or delayed DME claims. With the transition to a new revenue cycle system, denial frequency is expected to decrease, allowing this role to take a more strategic approach to AR optimization and trend identification.

You will not simply be entering claims. You will own follow-up, identify root causes, and help the team work smarter.

What You’ll Do

• Track and resolve unpaid, underpaid, or delayed DME claims
• Submit and follow up on Medicare, Medicaid, Commercial, and VA claims
• Interpret EOBs and ERAs and apply payments accurately
• Research payer policies, LCDs and NCDs, and coverage requirements
• Validate documentation including CMNs, prescriptions, proof of delivery, and prior authorizations
• Submit appeals when necessary and monitor outcomes
• Identify systemic issues and recommend process improvements
• Maintain detailed, compliant documentation within the billing system

What Success Looks Like

Phothera is seeking someone who brings initiative and ownership. This is not a passive billing role. The ideal candidate:

• Takes action without waiting to be directed
• Identifies patterns and inefficiencies
• Learns new systems quickly
• Brings urgency to AR follow-up
• Thinks beyond task completion and looks for ways to improve workflows

  Qualifications

  • 2+ years of experience in medical billing, accounts receivable, reimbursement, or revenue cycle management
  • Hands-on experience with professional/physician billing and CMS-1500 claims
  • Experience investigating and resolving unpaid, underpaid, rejected, and denied claims
  • Strong understanding of payer follow-up, EOBs/ERAs, claim corrections, and resubmissions
  • Experience working with Medicare, Medicaid, and commercial insurance payers
  • Working knowledge of CPT, HCPCS, modifiers, and medical necessity requirements
  • Ability to research claim issues, identify root causes, and independently determine appropriate next steps
  • Strong organizational skills with the ability to manage a high-volume claim inventory and follow issues through resolution
  • Comfortable working independently in a remote environment and adapting to evolving processes and priorities

  Preferred Qualifications

  • Experience with DME/DMEPOS billing and reimbursement
  • Experience interpreting payer coverage policies, LCDs/NCDs, or other medical necessity requirements
  • Experience preparing corrected claims, reconsiderations, and/or appeals
  • Familiarity with denial codes, CARCs/RARCs, clearinghouse edits, and payer portals
  • Experience in medical device, specialty therapy, home medical equipment, or another reimbursement-intensive healthcare environment
  • Experience identifying denial trends or recurring reimbursement issues and contributing to process improvements
  • Demonstrated ability to work effectively in a growing environment where processes and SOPs continue to evolve

  Compensation & Growth

  • Compensation: $28–$32 per hour
  • Monthly Bonus Opportunity: Employees may be eligible for a monthly bonus based on company performance. Bonus availability and amounts are not guaranteed and are subject to change.
  • Strong growth trajectory – Phothera is projected to nearly double in size
  • Opportunity for expanded responsibility and future leadership pathing

  About Phothera

  Phothera is a rapidly growing healthcare organization focused on expanding access to safe, effective phototherapy treatments. As part of Madison Industries, Phothera combines the stability of a global organization with the agility of a scaling healthcare innovator. The company is investing in people, systems, and infrastructure to support continued expansion and operational excellence.

  Why Join Now

  Phothera is transitioning to a new revenue cycle platform and refining workflows to improve efficiency and performance. This is a unique opportunity to help shape how the billing function operates moving forward while contributing to a mission-driven organization that directly impacts patient care.

  If you are energized by improving processes, strengthening revenue cycle performance, and contributing to a growing healthcare organization, we would love to connect.

  Phothera is an Equal Opportunity Employer and values diversity in the workplace. All qualified applicants will receive consideration for employment without regard to any protected status.