Medical Billing & Insurance Specialist

• Manage claims throughout the complete billing cycle
• Prepare, review, and submit accurate claims
• Monitor claim status and follow up on outstanding or unpaid claims
• Investigate and resolve rejected and denied claims
• Handle appeals and communicate with insurance companies as needed
• Identify billing issues that may delay or prevent reimbursement
• Maintain accurate billing records and support a healthy revenue cycle
• Verify patient eligibility, benefits, and coverage
• Work with vision insurance plans, Blue Cross/Blue Shield, UnitedHealthcare, Aetna, Medicare, and Medicaid
• Navigate payer portals, particularly Availity
• Complete insurance verification with an approximately 10-minute turnaround target
• Document coverage, benefits, and relevant insurance information
• Review and scrub claims before submission
• Confirm diagnosis codes support corresponding CPT/procedure codes
• Identify coding-related issues that could lead to claim denials or delayed payments
• Support clean and accurate claim submissions
• Follow the practice’s coding and billing guidelines
• Work closely with the medical scribe and other Virtual Assistants
• Maintain accurate and HIPAA-compliant patient and billing documentation
• Communicate billing or insurance issues clearly with appropriate team members
• Follow established clinic SOPs and billing processes
• Participate in training with the clinic team and outgoing medical biller to ensure a smooth transition

• Solid hands-on medical billing experience; training or certification alone does not qualify
• Experience managing full-cycle medical billing and revenue cycle management (RCM)
• Strong experience with medical claim preparation, submission, and follow-up
• Hands-on experience resolving claim denials and rejections and handling appeals
• Strong insurance eligibility and benefits verification experience
• Proficiency with Availity is required
• Experience navigating insurance/payer portals
• Experience working with commercial and/or government insurance plans such as Blue Cross/Blue Shield, UnitedHealthcare, Aetna, Medicare, and Medicaid
• Working knowledge of ICD-10, CPT codes, claim scrubbing, and medical coding principles
• Ability to identify billing or coding issues that could result in denials or delayed reimbursement
• Strong attention to detail, accuracy, organization, and follow-through
• Excellent written and spoken English
• Comfortable communicating with insurance companies and internal team members
• Ability to work independently while collaborating closely with the clinic team
• Ability to learn and follow clinic-specific billing SOPs
• Strong understanding of patient confidentiality and HIPAA requirements
• Must be able to submit an NBI Clearance and/or Local Police Clearance before onboarding
• Must be available for video meetings with the camera on when required
• Reliable laptop or desktop computer
• Stable high-speed internet connection, minimum 25 Mbps
• Noise-canceling headset
• Working webcam for virtual meetings
• Quiet and professional work environment
• TriZetto experience preferred but not required
• i-Pegasus experience is a plus but not required; training will be provided
• Optometry or ophthalmology billing experience is a plus but not required
• Previous remote or Virtual Assistant experience preferred but not required
• Medical or healthcare degree not required
• Active medical license not required
• Relevant professional medical billing experience is more important than a specific medical degree or license

• Dedicated HR & Contractor Support Team
• Premium VPN Access (Optional)
• HIPAA & Cybersecurity Training + Certification (Provided)
• Top 1% VA Performance Training
• Client-Approved U.S. Holidays
• Client-Approved Paid or Unpaid Time Off
• Access to Tools & Resources
• Optional Performance-Based Incentives
• Optional contractor perks and client-approved allowances