Medical Biller

GoTo Telemed seeks an exceptional Remote Medical Biller to manage comprehensive Revenue Cycle Management (RCM) operations for our rapidly expanding telehealth platform serving multiple medical specialties and healthcare providers nationwide. As a key member of our distributed RCM team, you will process, manage, and optimize medical claims for an increasing portfolio of telehealth providers—with new clients and provider networks added every month as our organization scales.

In this critical role, you will be the financial backbone of our provider network, managing the complete end-to-end billing lifecycle including patient eligibility verification, insurance claim submission, payment posting, accounts receivable follow-up, and comprehensive denial management. Your expertise in medical coding (CPT, ICD-10-CM, HCPCS), telehealth modifiers, payer policies, and compliance will directly impact provider revenue, patient satisfaction, and our organizational growth trajectory.

This position offers exceptional opportunity for professional growth, career advancement, and organizational scaling as GoTo Telemed expands its provider network and service offerings monthly. You will receive comprehensive training, access to cutting-edge RCM tools and resources, and mentorship to develop into a senior RCM specialist or team lead.

Why Join GoTo Telemed

Unlimited Growth Opportunity

• Monthly Provider & Client Expansion: As GoTo Telemed adds new healthcare providers and medical specialties every month, your responsibilities and earning potential expand proportionally
• Scalability without Chaos: We implement systematic processes, training, and resources to ensure smooth scaling—you grow professionally without being overwhelmed
• Career Advancement Path: Progress from Medical Biller → Senior Biller → RCM Team Lead → RCM Manager → Director of Revenue Operations
• Skill Diversification: Work with multiple medical specialties (primary care, cardiology, orthopedics, behavioral health, urgent care, etc.), expanding your coding and compliance expertise

Comprehensive Support & Resources

• Professional Training Programs: Formal onboarding, continuous education on CPT/ICD-10 updates, telehealth policy changes, and payer-specific requirements
• Certification Support: Full reimbursement for CPB, CPC, CCA, or other healthcare credentials; study time and exam fees covered
• Advanced RCM Technology: Access to best-in-class practice management systems, claims clearinghouses, coding software, and automation tools
• Expert Mentorship: Paired with experienced RCM professionals for guidance on complex coding scenarios, denial resolution, and process optimization
• Peer Collaboration: Work with a talented distributed team of medical billers, coders, and RCM specialists—regular team meetings, knowledge sharing, and collaborative problem-solving

Remote Work Flexibility

• 100% Work-from-Home: Eliminate commuting; work from anywhere with reliable internet
• Flexible Schedule: Core hours 8 AM – 5 PM CST, with flexibility for medical appointments, personal needs, and work-life balance
• Home Office Support: $500 annual stipend for home office equipment, internet upgrades, and ergonomic setup
• Distributed Team Culture: Collaborate with colleagues across time zones; async communication tools support flexible scheduling

Financial Rewards & Growth

• Performance-Based Incentives: Earn bonuses based on claims processed, approval rates, AR reduction, and denial prevention—your accuracy and efficiency directly increase earnings
• Annual Raises & Reviews: Merit-based salary increases tied to performance, certifications, and expanded responsibilities
• Unlimited Earning Potential: As the provider network grows, so do opportunities for higher-volume processing, team oversight, and management roles with corresponding salary increases
• Transparent Compensation: Clear performance metrics and bonus structure; you always know how to increase earnings

Primary Responsibilities

Insurance Eligibility & Verification

• Verify patient medical insurance eligibility and benefits prior to telehealth appointment scheduling using secure insurance verification portals and phone verification
• Confirm coverage details including deductibles, out-of-pocket maximums, copays, coinsurance, frequency limitations, and telehealth coverage status
• Identify medical necessity requirements, pre-authorization, and referral requirements; obtain all necessary approvals before service delivery
• Maintain accurate, current insurance information in practice management systems; update policies when changes occur
• Identify coverage gaps, exclusions (telehealth limitations, specialty exclusions, etc.), and conditions affecting billing and collections
• Document all verification activities and flag special requirements or coverage concerns for clinical and billing teams

Patient Registration & Demographics

• Ensure complete, accurate patient demographic and insurance data capture at appointment booking
• Validate patient information accuracy (name, date of birth, insurance policy numbers, group numbers, member IDs, etc.)
• Update patient records when insurance changes, policies renew, or coverage terminations occur
• Communicate patient financial responsibilities, copays, deductibles, and projected out-of-pocket costs before service delivery
• Capture patient consent for services and billing; document in compliance with HIPAA and state telehealth regulations

Medical Coding & Claims Preparation

• Accurately code telehealth visits and medical services using Current Procedural Terminology (CPT) codes and appropriate modifiers
• Assign correct ICD-10-CM codes for all diagnoses documented in clinical notes
• Apply telehealth-specific modifiers (93 for audio-only, 95 for audio/video synchronous, GT, FQ, FR) in accordance with payer policies and CMS guidance
• Verify correct place of service (POS) coding for telehealth encounters (POS 02 for provider office, POS 10 for patient home, POS 11 for patient location as specified)
• Ensure complete charge capture and accurate medical necessity documentation; identify any missing information before claim submission
• Review clinical documentation for specificity (laterality, severity, complexity) and communicate coding queries to providers when documentation is insufficient
• Stay current with annual CPT/ICD-10 updates, new telehealth codes (98000-series), and payer-specific coding requirements

Claims Submission & Management

• Submit medical claims electronically through clearinghouses (837 EDI format) within 3-5 days of service delivery
• Prepare and manage claims via multiple submission pathways: electronic clearinghouse, direct payer portals, and print-to-mail for specific payers or situations
• Track all submitted claims with documentation of submission date, claim number, claim status, and clearinghouse identification
• Monitor claim status continuously; flag claims at risk of denial or delay for proactive follow-up
• Manage front-end claim edits and rejections; correct claim errors and resubmit within 24 hours
• Comply with all payer-specific requirements: claim format, documentation attachments, modifier usage, and submission deadlines
• Maintain detailed claim tracking logs for audit and reporting purposes

Accounts Receivable (AR) Follow-Up & Collections

• Monitor outstanding claims daily; conduct systematic follow-up on all claims past 15, 30, 45, and 60 days
• Contact insurance companies via phone, email, and secure payer portals to obtain claim status, identify delay reasons, and resolve pending issues
• Review Explanations of Benefits (EOBs) and identify payment discrepancies, underpayments, or improper adjustments
• Send timely patient statements weekly for patient responsibility balances exceeding 30 days
• Follow up on patient balances through professional phone calls, patient statements, and secure messaging
• Implement systematic collection procedures for patient accounts 30+ days past due
• Negotiate payment plans and settlements with patients while maintaining professional, ethical communication
• Document all collection activities, patient communications, and payment arrangements in patient records
• Maintain compliance with Fair Debt Collection Practices Act (FDCPA) and state collection laws

Claims Denial Management & Appeals

• Analyze all claim denials and rejections; identify root causes (coding errors, missing documentation, eligibility issues, medical necessity, prior authorization gaps, etc.)
• Prepare corrected claims with necessary documentation changes; resubmit per payer guidelines
• Prepare formal written appeals for denied claims with supporting clinical documentation and policy justification
• Track appeal submissions and responses; resubmit appeals as needed until resolution
• Calculate impact of denials on provider revenue; prioritize high-value or recurring denials for focused remediation
• Maintain denial tracking reports to identify patterns by payer, code, diagnosis, or provider
• Implement process improvements to prevent recurrence of common denial reasons
• Identify underpayments and contractual adjustment errors; prepare documentation for recovery or credit adjustment

Payment Posting & Reconciliation

• Post insurance payments and Explanations of Benefits (EOBs) to patient accounts accurately and timely
• Reconcile posted EOBs with submitted claims and identify discrepancies, missing payments, or claim-to-claim variation
• Post patient payments from multiple sources: patient payments, payment plans, refund processing
• Apply payments to correct patient accounts and claim lines; maintain clear audit trail for all transactions
• Process contractual adjustments and write-offs per payer fee schedules and provider agreements
• Reconcile monthly insurance payments and EOBs with banking records; reconcile provider revenue reports
• Identify and resolve payment discrepancies, missing EOBs, and payment delays within 5 business days

Print-to-Mail Operations

• Identify claims, appeals, and patient statements requiring physical mail delivery per payer requirements
• Prepare documentation for printing and mailing; ensure compliance with HIPAA Privacy Rule requirements
• Maintain print-to-mail logs with tracking information and addresses
• Verify patient and provider mailing addresses; ensure HIPAA-compliant delivery
• Track delivery of critical documents using postal tracking when available and appropriate

Reporting & Analytics

• Generate daily claim processing reports (claims submitted, claims pending, claims approved)
• Produce weekly and monthly revenue cycle reports including:
• Days in Accounts Receivable (DAR) by payer
• Claim submission volume and claim approval rates
• Denial rates, denial reasons, and denial trends
• Patient collection rates and aging AR analysis
• Payment posting timeliness and payment discrepancies
• Clean claim rates (first-pass acceptance)
• Identify trends and process improvement opportunities; communicate findings to management
• Track Key Performance Indicators (KPIs) and compare performance against industry benchmarks
• Support management reporting and financial forecasting

Requirements

Compliance & Documentation

• Maintain strict adherence to HIPAA Privacy Rule, Security Rule, and Breach Notification Rule
• Ensure all patient communications comply with state-specific telehealth patient rights and privacy requirements
• Follow OIG compliance program guidelines including periodic HHS OIG LEIE database checks
• Comply with Anti-Kickback Statute (AKS), Stark Law, and False Claims Act requirements in all billing activities
• Document all billing activities, communications, and decisions in patient records for audit readiness
• Maintain confidentiality of patient Protected Health Information (PHI) at all times
• Report potential compliance concerns through established compliance and ethics channels
• Participate in compliance training annually and whenever policies are updated

Multi-Specialty & Multi-Payer Experience

• Manage claims across multiple medical specialties and service types as GoTo Telemed expands its provider network
• Learn specialty-specific coding requirements (behavioral health, primary care, specialty visits, behavioral health, etc.)
• Adapt to evolving payer policies and coverage decisions as new providers and payers are added monthly
• Share knowledge with new team members as the RCM team scales
• Support training of new medical billers joining the team

Required Qualifications & Skills

Education & Certification

• High school diploma or GED required
• Formal training in medical billing, medical coding, healthcare administration, or related field required
• Current or willingness to obtain medical billing certifications within 12 months:
• Certified Professional Biller (CPB) through AAPC (preferred)
• Certified Professional Coder (CPC) through AAPC (preferred)
• Certified Coding Associate (CCA) through AAPC
• Certified Healthcare Billing and Management Executive (CHBME)
• Comprehensive, current knowledge of:
• CPT codes and medical coding principles
• ICD-10-CM diagnostic coding
• HCPCS Level II codes
• Telehealth-specific modifiers (93, 95, GT, FQ, FR)
• Medical terminology and anatomy.

Professional Experience

• Demonstrated telehealth/telemedicine billing experience strongly preferred
• Hands-on experience with insurance verification and patient eligibility determination
• Professional experience with medical claims submission (electronic and paper)
• Direct accounts receivable follow-up and patient collections experience
• Denial management and claims appeal experience
• EOB/ERA reconciliation and payment posting experience
• Experience with multiple medical specialties (primary care, urgent care, specialty practices, etc.) preferred
• Experience with multi-state provider networks and varying payer policies preferred

Technical Skills & Software Proficiency

• Advanced proficiency with Microsoft Office Suite (Excel, Word, Outlook)
• Hands-on experience with medical billing software and practice management systems (eClinicalWorks, Athenahealth, Kareo, NextGen, Medidata, or similar platforms)
• Proficiency with electronic health record (EHR) systems common to telehealth environments
• Experience with insurance company portals, claim submission systems, and clearinghouses (Availity, Change Healthcare, Emdeon, NTPC)
• Strong data entry, spreadsheet, and database management skills
• Familiarity with medical coding software and/or encoder systems (OptumInsight, Codebook, Pathways, etc.)
• Ability to navigate multiple software platforms simultaneously and switch between systems efficiently
• Comfort learning new software and platforms quickly as organizational tools evolve

Compliance & Regulatory Knowledge

• Comprehensive understanding of HIPAA Privacy Rule, Security Rule, and Breach Notification Rule
• Working knowledge of OIG Anti-Kickback Statute, Stark Law, and exclusion list compliance
• Understanding of CMS Medicare policies, modifiers, and reimbursement methodologies for telehealth
• Knowledge of state-specific telehealth regulations and billing requirements (particularly states where GoTo Telemed operates)
• Familiarity with medical necessity and coverage determination processes
• Understanding of CPT coding standards, payer-specific coding guidelines, and LCD/NCD policies
• Knowledge of Explanation of Benefits (EOB) interpretation and claim-to-EOB reconciliation

Soft Skills & Competencies

• Attention to Detail: Exceptional accuracy in data entry, coding, claims processing, and payment reconciliation; ability to spot and correct errors
• Communication: Strong written and verbal communication skills for professional interaction with patients, insurance companies, healthcare providers, and internal teams; ability to explain complex billing concepts clearly
• Problem-Solving: Analytical ability to investigate claim denials, identify root causes, research payer policies, and implement solutions
• Time Management: Ability to prioritize multiple tasks, manage high claim volumes, and meet established deadlines consistently
• Customer Service: Patience, professionalism, and empathy when handling patient billing inquiries and collections conversations
• Organization: Ability to maintain accurate records, manage complex workflows, and track multiple claims across stages
• Analytical Thinking: Ability to interpret EOBs, identify trends, create process improvements, and contribute to data-driven decision-making
• Professionalism: Unwavering commitment to ethical billing practices, regulatory compliance, and patient confidentiality
• Adaptability: Ability to learn new systems, adjust to evolving payer policies and regulations, and handle changing priorities
• Self-Direction: Ability to work independently in a remote environment; strong self-motivation and ownership of responsibilities
• Growth Mindset: Enthusiasm for professional development, certification, and expanding expertise across specialties and payers

Preferred Qualifications

• Active Certified Professional Biller (CPB) or Certified Professional Coder (CPC) certification
• Experience with multiple state healthcare regulations and licensure requirements
• Knowledge of managed care, capitation, and alternative reimbursement models
• Experience with RPA (Robotic Process Automation) or medical billing automation and workflow tools
• Behavioral health or mental health telehealth billing experience
• Multi-specialty coding experience (primary care, urgent care, orthopedics, cardiology, etc.)
• Experience with insurance appeals, litigation support, and legal hold documentation
• Bilingual capabilities (English + Spanish or other languages aligned with patient populations)
• Previous experience in medical billing team leadership or mentoring
• Knowledge of healthcare revenue cycle analytics and financial reporting
• Experience with vendor management or integration of multiple billing systems

Work Environment & Schedule

• Work Setting: 100% Remote (work from home); operates from any location within the United States with reliable high-speed internet
• Core Hours: 8:00 AM – 5:00 PM CST, Monday–Friday
• Schedule Flexibility: Schedule flexibility available within core hours for medical appointments, personal needs, and work-life balance; manager approval required for significant changes
• Occasional Overtime: May be required during high-volume periods, month-end close, or AR aging campaigns (paid at overtime rate)
• Shift Availability: Willingness to adjust schedule to accommodate new provider launches or peak processing periods (communicated in advance)
• Communication: Regular availability via email, chat, video calls, and phone during core hours; async communication tools support flexible coordination
• Technology Requirements: Personal computer (Windows or Mac, meeting minimum specifications), dual monitors recommended for efficiency, high-speed internet (minimum 25 Mbps), secure encrypted data storage, HIPAA-compliant communication devices
• Professional Development: Participation in monthly training, quarterly compliance updates, and annual strategy meetings (some may be virtual group sessions)

Physical & Mental Demands

• Ability to sit for extended periods at a computer workstation (6–8 hours daily)
• Ability to read small print and review detailed documentation accurately; comfort with computer screens for extended periods
• Strong focus and concentration for sustained periods; ability to maintain accuracy amid distractions
• Emotional resilience when managing difficult collection conversations and high-pressure situations
• Ability to multitask and context-switch between claims, patients, and payers while maintaining accuracy
• Ability to handle sensitive patient information with discretion and professionalism
• Physical dexterity for keyboard and mouse use
• Reliable, stable internet connection and quiet workspace environment

Compliance, Background & Regulatory Requirements

Pre-Employment & Ongoing Verification:

• OIG Exclusion List Check: Candidate will be checked against HHS OIG LEIE database before hire; periodic re-verification conducted annually
• Background Check: Standard criminal background check required per healthcare industry standards; no felony convictions or healthcare fraud history
• State Medical Billing License Verification: If applicable to candidate's state, verification of any required healthcare administrative or medical billing licenses
• Tax Identification Verification: W-4 and IRS verification for employment eligibility
• HIPAA Compliance Certification: Mandatory HIPAA Privacy and Security training required before starting date; annual recertification required
• Professional Conduct Agreement: Signature confirming commitment to ethical billing practices, fraud and abuse law compliance, and state medical practice regulations
• Exclusion List Monitoring: Candidate agrees to annual re-verification against HHS OIG LEIE and state-specific exclusion databases during employment
• Confidentiality & NDA: Execution of Business Associate Agreement (BAA) and non-disclosure agreement