Insurance Medical jobs

Our orthopedic practice is seeking an experienced Medical Biller & Credentialing Specialist to join our team remotely. This dual-function role is primarily responsible for handling provider enrollment and payer credentialing to ensure our physicians and advanced practice providers remain in good standing with all insurance networks. However at the same time the candidate will be expected to also work on billing related tasks especially AR follow up.

The ideal candidate has hands-on orthopedic billing experience (including surgical and DME claims), a strong understanding of payer credentialing processes, experience with worker's compensation billing, and can work independently in a fast-paced, detail-driven environment.

Key Responsibilities

Medical Billing

• Prepare, review, and submit clean claims for orthopedic office visits, procedures, surgeries, injections, DME, and physical therapy services
• Apply correct CPT, ICD-10, and HCPCS coding in collaboration with providers and coding staff
• Verify insurance eligibility and benefits, including prior authorizations for surgeries and imaging
• Post payments, adjustments, and denials; reconcile EOBs/ERAs
• Investigate and resolve claim denials, rejections, and underpayments; file timely appeals
• Manage accounts receivable follow-up and aging reports to minimize days in A/R
• Communicate with patients regarding billing questions, statements, and payment plans
• Stay current on payer-specific orthopedic billing guidelines (Medicare, Medicaid, commercial, and workers' comp)

Credentialing

• Manage initial credentialing and re-credentialing for physicians and APPs with commercial payers, Medicare, and Medicaid
• Maintain CAQH profiles and ensure timely attestation updates
• Track expirables (licenses, DEA, malpractice insurance, board certifications) and manage renewal timelines
• Complete and submit payer applications, hospital privileging paperwork, and facility credentialing documents
• Maintain accurate provider files and credentialing databases/trackers
• Serve as liaison between providers, payers, and practice administration on enrollment status
• Monitor and resolve credentialing-related claim denials (e.g., provider not enrolled/linked)

Qualifications

• 3+ years of medical billing experience, with orthopedic billing experience strongly preferred
• 1+ years of payer credentialing/provider enrollment experience
• Working knowledge of CPT, ICD-10, HCPCS, and modifiers relevant to orthopedics (e.g., surgical modifiers, global periods)
• Experience with CAQH, PECOS, NPPES, and payer portals (Availity, Medicare, Medicaid, major commercial payers)
• Experience billing worker's compensation claims
• Familiarity with EHR/practice management systems
• Strong understanding of revenue cycle management and denial management
• Excellent written and verbal communication skills
• Highly organized, self-motivated, and comfortable managing deadlines independently in a remote setting
• Certification preferred: CPC, CPB, CPMSM, or CPCS (or willingness to obtain)

Work Environment

• Fully remote position; must have a reliable, private workspace and high-speed internet
• 8am-5pm Pacific Time, Monday–Friday
• Daily virtual meetings with billing and administrative teams

Pay: ₹430.00 - ₹650.00 per hour

Expected hours: 40.0 per week

Application Question(s):

• Have you worked with state-specific workers' comp fee schedules? Which states?
• Please describe your experience with credentialing and contracting?
• Please describe your experience with the orthopedic specialty?

Experience:

• medical billing: 3 years (Required)
• orthopedic: 1 year (Required)
• credentialing: 1 year (Required)
• Epic EMR: 1 year (Preferred)

Work Location: Remote