Virtual Medical / Dental Biller

We are seeking a detail-oriented, analytical, and highly organized Virtual Medical / Dental Biller to manage the full revenue cycle of a healthcare practice. In this role, you will be responsible for ensuring accurate reimbursement by handling everything from initial claim submission to aging accounts receivable and denial resolution.

The ideal candidate possesses deep foundational knowledge of medical or dental coding, an eagle eye for administrative compliance, and a persistent approach to resolving payment discrepancies with insurance payers.

Core Responsibilities

Claims Prep, Coding & Submission

• Claim Lifecycle Management: Prepare, review, and electronically submit clean medical (CMS-1500) or dental (ADA) claims to clearinghouses and insurance companies.
• Coding Compliance: Verify that all treatments, encounters, and diagnoses are matched with the correct, most up-to-date codes (ICD-10, CPT, HCPCS, or CDT) to ensure compliance and prevent rejections.
• Scrubbing & Validation: Review clinical documentation prior to submission to ensure all necessary modifiers, clinical notes, and pre-authorizations are attached.

Denial & Rejection Management

• RCA (Root Cause Analysis): Track, analyze, and appeal rejected or denied claims promptly.
• Appeals Processing: Research payer policies, draft formal appeal letters, and submit corrected claims or necessary medical/dental narratives to overturn adverse determinations.

Accounts Receivable (A/R) & Insurance Follow-Up

• Aging Reports: Consistently monitor and work the insurance aging reports (30/60/90+ days) to minimize outstanding balances.
• Payer Communication: Actively follow up with insurance representatives via web portals and phone inquiries to investigate delayed payments and resolve billing bottlenecks.

Payment Posting & Payment Reconciliation

• Financial Ledgering: Accurately post insurance payments, contractual adjustments, and patient liabilities from Electronic Remittance Advices (ERAs) and Explanation of Benefits (EOBs) into the practice management system.
• Balancing: Reconcile daily financial logs to ensure posted payments match deposit records perfectly.

Requirements

Required Qualifications

• Experience: Minimum 2–3 years of dedicated medical or dental billing experience within a U.S. healthcare setting.

• Coding Expertise: Proven fluency in navigating and applying standard coding systems (ICD-10-CM, CPT, HCPCS for medical; CDT for dental). Certification (e.g., CPC, CBCS, CMRS, or CDC) is a strong plus.
• Software Agility: Hands-on experience using mainstream medical/dental EMR/EHR platforms (e.g., eClinicalWorks, AdvancedMD, ModMed, Open Dental, Dentrix) and clearinghouses (e.g., Change Healthcare, Availity).
• Financial Literacy: Strong understanding of the complete revenue cycle, including EOB interpretation, coordination of benefits (COB), and deductibles vs. co-insurance rules.
• Infrastructure: A secure, dedicated home office that meets HIPAA data privacy requirements, paired with high-speed internet and a reliable computer system.

Originally posted on Himalayas