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):