We are looking for an experienced Senior Medical Biller with 7+ years of hands-on experience in US Healthcare Provider-side Revenue Cycle Management (RCM), particularly in Accounts Receivable (A/R), Denial Management, Appeals, Payment Posting, and Collections.

The successful candidate will independently manage assigned billing accounts, perform end-to-end claim follow-up, identify and resolve denial and payment issues, prepare appeals, and work directly with healthcare practices and insurance payers.

This is a client-facing position, so strong communication, relationship management, analytical ability, and professional judgment are essential.

Key Responsibilities

1. Medical Billing & Revenue Cycle Management

- Manage the complete medical billing and collections cycle for assigned client accounts.
- Ensure claims are accurately prepared, submitted, and followed up within payer timelines.
- Perform insurance verification, claim status checks, payment research, and account follow-up.
- Work extensively with insurance portals including Medicare, Medicaid, CHAMPS, and other payer platforms.
- Ensure timely resolution of billing issues to maximize reimbursement and reduce outstanding A/R.
- Maintain accurate documentation of all billing activities and account actions.

2. A/R & Denial Management

- Perform detailed A/R follow-up on outstanding and aged accounts.
- Analyze A/R reports to identify trends, payment delays, underpayments, and high A/R days.
- Investigate and resolve claim denials, rejections, and payment discrepancies.
- Identify recurring denial patterns and perform root cause analysis (RCA).
- Track and document top denial reasons and apply appropriate denial codes in the billing system.
- Develop appropriate action plans to reduce recurring denials.
- Maintain consistent follow-up on unresolved claims until appropriate resolution.

3. Appeals & Reconsiderations

- Prepare and submit payer appeals and reconsideration requests for denied claims.
- Handle Medicare reconsiderations/appeals in accordance with applicable procedures.
- Demonstrate a strong understanding of the documentation and information required to support an appeal.
- Understand and appropriately handle processes related to ABN (Advance Beneficiary Notice) and COB (Coordination of Benefits).
- Research payer policies and supporting documentation to strengthen appeal outcomes.
- Monitor appeal status and ensure timely follow-up through resolution.

4. Payment Posting & Reconciliation





- Review and interpret EOBs (Explanation of Benefits) and payment vouchers.
- Post insurance and patient payments accurately in the billing system.
- Reconcile payments against claims and identify discrepancies, contractual adjustments, and underpayments.
- Research and resolve payment posting issues.
- Ensure all financial transactions are properly documented and supported.

5. Medical Coding & Claims Accuracy

- Apply a strong working knowledge of ICD-10 and CPT coding requirements.
- Review claims for billing accuracy and payer-specific requirements.
- Identify coding-related issues that may contribute to denials or delayed reimbursement.
- Work with relevant internal teams to resolve coding and documentation issues.

6. Client & Payer Communication

- Communicate directly with healthcare practices regarding billing clarifications, documentation requirements, claim issues, and dispute resolution.
- Maintain professional and effective relationships with clients and payer representatives.
- Contact insurance companies and payer representatives to research claim status and resolve outstanding issues.
- Clearly document all payer and client interactions.
- Perform post-call analysis and record appropriate after-call actions for claim follow-ups.

7. Compliance & Documentation

- Maintain strict compliance with HIPAA requirements related to patient privacy, access, and release of information.
- Follow payer-specific regulations, healthcare compliance requirements, company policies, and established billing procedures.
- Maintain complete and accurate documentation within client software and billing systems.
- Ensure documentation supports insurance submissions and provides a clear audit trail.
- Stay current with changes in payer policies, billing guidelines, and healthcare regulations.

8. Process Improvement & Reporting

- Analyze billing and A/R data to identify operational issues and improvement opportunities.
- Provide regular reporting on A/R, denials, appeals, collections, and account performance.




- Identify trends and recommend corrective actions to improve revenue cycle performance.
- Collaborate with internal teams to reduce denials and improve billing efficiency.
- Contribute to process standardization and continuous improvement initiatives.

Must-Have Skills

- 7+ years of experience in US Healthcare Provider-side RCM.
- Strong hands-on experience in:
- A/R Follow-up
- Denial Management
- Medical Billing
- Appeals & Reconsiderations
- Payment Posting
- Collections

- Strong understanding of the US healthcare revenue cycle.
- Experience working with Medicare and Medicaid.
- Hands-on experience with insurance portals such as CHAMPS, Medicare, and Medicaid.
- Strong understanding of EOBs, claim status, payment vouchers, denials, and payer processes.
- Strong knowledge of ICD-10 and CPT coding concepts.
- Understanding of HIPAA and healthcare compliance requirements.
- Excellent written and verbal communication skills.
- Strong analytical and problem-solving abilities.
- Ability to independently manage billing accounts and prioritize A/R follow-ups.
- Strong client relationship and stakeholder management skills.

Preferred Technical Skills

Experience with TriZetto platforms is highly preferred.

Experience with other healthcare clearinghouse and payer platforms such as:

- Waystar
- Availity
- Similar RCM/clearinghouse platforms

Required Qualifications

- Bachelor's degree in Healthcare Administration, Business Administration, or a related field.
- Minimum 7 years of relevant experience in US Healthcare Provider-side RCM, with solid exposure to A/R and Denial Management.
- Strong understanding of medical billing, coding, collections, and payer processes.
- Experience working independently on assigned client accounts.
- Excellent communication and interpersonal skills.
- Strong organizational skills and attention to detail.
- Ability to multitask, prioritize workloads, and meet strict deadlines.
- Comfortable working in a remote environment and during US-aligned working hours.

Why Join ModuleMD?

- Work at the intersection of AI, healthcare, and Revenue Cycle Management.
- Opportunity to work with innovative healthcare technology and EHR/Practice Management solutions.
- Work with US healthcare providers and gain exposure to complex RCM operations.
- Join a mission-driven team that values curiosity, autonomy, collaboration, and innovation.
- Remote work environment from India.
- Culture focused on continuous learning and professional growth.

📌 Senior Medical Biller (India)
🏢 ModuleMD Healthcare Solutions
📍 India