Medical Biller and RCM Specialist

We are seeking an experienced, detail-oriented, and highly analytical Medical Biller and RCM Specialist to support a busy mental health clinic led by Dr. Mann. In this critical revenue-recovery role, you will initially oversee and audit the output of an external, third-party medical billing company whose contract runs through April 2027. With approximately 90 days of pending billing and 500+ outstanding patient encounters, your mission is to identify claim bottlenecks, resolve billing errors, hold the external agency accountable, and directly recapture revenue for the practice.

The ideal candidate possesses 3+ years of U.S. medical billing and coding experience, specialized background in mental/behavioral health billing, and strong familiarity with California payer landscapes, Medi-Cal, and complex state compliance regulations. This position starts as a part-time role (~20 hours/week) for the first month with a direct path to full-time employment as you take over full in-house billing operations.

Working Environment & Core Schedule

• Role Title: Virtual Medical Billing Specialist & Revenue Oversight Lead
• Specialty: Mental Health / Behavioral Health Clinic
• Status: Part-Time (~20 Hours / Week for Month 1) transitioning to Full-Time based on revenue recovery and operational demand
• Schedule: Flexible 4–5 hours per day within Monday – Friday, 10:00 AM – 7:00 PM PST (Pacific Standard Time)
• Core Technology Stack: OnlyMD EMR & Billing System, Practice VoIP System, Dedicated Company Email Domain
• Primary Objective: Revenue recovery, clearing a 500+ encounter backlog, external billing agency audit, and claim resolution

Top 3 Daily Tasks

1. External Billing Agency Audit & Monitoring: Review daily submissions from the current third-party billing company, cross-referencing OnlyMD EMR encounters against filed claims to uncover unbilled encounters, coding errors, and dropped tasks.
2. Backlog Clearance & Outstanding Claim Follow-Up: Investigate approximately 90 days of pending billing and 500+ unsubmitted encounters; communicate directly with payors and the billing agency to resolve rejections and denials.
3. Billing List & Patient Account Management: Maintain organized billing tracking logs in OnlyMD, resolve patient insurance eligibility discrepancies, and provide Dr. Mann with transparent weekly AR recovery reports.

Core Responsibilities

• Third-Party Agency Oversight: Serve as the practice’s internal watchdog—auditing the external vendor's work, tracking claim transmission cadences, and flagging systematic errors or delays.
• Mental Health Billing & Coding Audit: Ensure accurate CPT/ICD-10 coding for behavioral health encounters, therapy sessions, and psychiatric evaluations within OnlyMD.
• Claims Tracking & Denial Management: Identify root causes for unpaid, rejected, or unsubmitted claims; execute corrective actions, appeals, and resubmissions.
• Payor & Regulatory Compliance: Navigate complex California state medical billing regulations, county/state-specific paperwork, and commercial/government payor guidelines to streamline credentialing and reimbursement.
• Full In-House Transition Preparation: Document billing workflows and prepare the practice to seamlessly bring 100% of billing operations in-house when the third-party contract concludes.