US Medical Billing and Claims Specialist (WFH)

About Penbrothers

Penbrothers is an HR & remote talent management partner and one of the fastest growing companies in the Philippines. We provide talented Filipinos with global opportunities in high-growth startups and dynamic companies, from the comfort of their own homes.

About the Client

Our client is a venture-backed startup with a mission to establish a new standard of affordable, preventative care beyond the traditional hospital setting. They achieve this by enabling independently-owned practices to accept and work with insurance profitably. The client champions the voices of small private practices in an industry dominated by large health systems. Through strategic partnerships with insurance carriers, they eliminate the risk and administrative hurdles associated with insurance, empowering entrepreneurial providers to launch and expand successful in-network practices, ultimately increasing access to affordable healthcare across the US.

About the Role

We are seeking a detail-oriented Medical Billing and Claims Specialist to play a crucial role in our revenue operations team. In this position, you will serve as an expert on all aspects of claims management, including but not limited to the daily submission of claims, posting payments, denials management, and client billing support. You will collaborate closely with providers, patients, and insurance companies to resolve billing issues, process claims, and ensure compliance with healthcare regulations.

What you’ll do

• Oversee the quality and execution of daily claim submissions and payment transactions.

• Manage the daily reconciliation of charges, adjustments, and payments.

• Follow up on claims and submit reconsiderations and appeals as needed.

• Interact with providers and clients in a positive, professional manner, with a sensitive approach to discussions regarding financial matters.

• Maintain, enhance, and document knowledge of key rules and best practices related to revenue cycle operations.

• Keep the team informed of changes in insurance company policies and guidelines.

• Assist the team with other functions as needed or requested.