Senior Medical Biller

Senior Medical Biller (eClinicalWorks Required)

Remote | Full-Time | Independent Physician Practice

About OptiClaim Business Solutions OptiClaim Business Solutions LLP is a specialized healthcare revenue cycle management and staffing firm operating across India and U.S. markets. We partner with independent physicians and small-to-mid-size practices to build high-performance billing operations — from credentialing and coding through collections and compliance. We are currently expanding our U.S. client portfolio and seeking a seasoned RCM professional to take full ownership of a physician billing account.

Role Overview We are seeking a Revenue Cycle Manager / Senior Medical Biller to lead the complete professional billing function for an independent physician practice operating across outpatient clinic, hospital, and skilled nursing facility (SNF) / nursing home settings. This is not a supervisory-only role. The right candidate is a working RCM lead — someone who can independently manage charge entry, coding review, claim submission, AR follow-up, denial management, credentialing, and reporting, while building out a scalable billing department over time. Strong, hands-on experience with eClinicalWorks (eCW) is mandatory. Candidates without eCW experience will not be considered.

Key Responsibilities Revenue Cycle & Billing Operations Manage the full professional billing lifecycle: charge capture → charge entry → claim scrubbing → electronic claim submission → ERA/EOB posting → AR follow-up → denial management → collections Ensure timely and accurate claim submission for all service lines: primary care / outpatient clinic, hospital visits (inpatient and outpatient), nursing home / SNF visits, procedures, labs, and diagnostic interpretations Monitor accounts receivable (AR) aging, track days in AR, and resolve outstanding claims proactively Maintain clean claim rates and minimize denial rates through front-end and back-end billing controls Manage payer-specific billing rules, fee schedules, and contract terms for Medicare, Medicaid, and commercial payers

Coding & Documentation Review Review provider documentation and assign accurate CPT codes, ICD-10-CM diagnosis codes, and applicable modifiers Validate E/M level selection for office visits (99202–99215), hospital visits (99221–99223, 99231–99233), nursing home visits (99304–99310), and discharge services Ensure procedure coding compliance for in-office procedures, preventive services, lab orders, and diagnostic interpretations Identify documentation gaps and work directly with the provider to correct or addend clinical notes Maintain coding compliance with CMS guidelines, payer LCD/NCD policies, and OIG standards

eClinicalWorks (eCW) Billing Management Manage all billing workflows inside eClinicalWorks: charge entry, claim scrubbing, claim submission, and rejection workqueues Post insurance payments, patient payments, contractual adjustments, and write-offs Work claim edits and clearinghouse rejections through eCW and the integrated clearinghouse (e.g., Waystar, Change Healthcare) Run and analyze billing reports, productivity reports, and payer performance reports inside eCW Maintain and update fee schedules, payer setups, referring provider data, and place-of-service configurations Optimize billing workflows and workqueue management to improve throughput and reduce lag time

Payer Relations & AR Follow-Up Conduct proactive AR follow-up on all outstanding claims across Medicare, Medicaid (state), and commercial payers Use payer portals (Navinet, Availity, Emdeon, payer-direct portals) for real-time claim status, remittance review, and appeal submissions Manage denial root cause analysis (RCA) — identify patterns in denials by payer, denial reason code, and service type Write and submit formal appeals with supporting clinical documentation, medical necessity letters, and payer-specific appeal forms Track and resolve coordination of benefits (COB), timely filing, authorization, and medical necessity denials Maintain low AR days outstanding and report aging metrics to leadership on a regular cadence

Credentialing & Provider Enrollment Manage initial provider credentialing and re-credentialing with Medicare (PECOS), Medicaid (state MACs), and commercial health plans Maintain and update provider CAQH ProView profile and ensure attestation is current Complete payer enrollment applications, follow up on pending enrollments, and resolve enrollment-related billing holds Ensure provider is actively enrolled and linked at all billing locations (clinic NPI, hospital NPI, SNF NPI) Track credentialing expiration dates, DEA renewals, state license renewals, and malpractice certificates

Reporting & Compliance Produce monthly RCM performance dashboards: gross charges, net collections, collection rate, denial rate, days in AR, and payer mix analysis Monitor for HIPAA compliance in all billing, coding, and data handling workflows Stay current on CMS annual updates (CPT, ICD-10, RBRVS fee schedule, MPFS, E/M guideline revisions) Flag compliance risks and assist in implementing corrective action plans (CAPs) as needed

Team Leadership (Growth Phase) Assist in recruiting, onboarding, and training medical billers, coders, and AR specialists as the department grows Build standard operating procedures (SOPs), workqueue management protocols, and QA checklists for the billing team Conduct productivity and quality audits on billing staff Serve as the operational lead for all revenue cycle functions

Required Qualifications Minimum 5 years of experience in medical billing and revenue cycle management Minimum 2–3 years in a senior biller, lead biller, billing supervisor, or RCM manager role Strong experience in professional fee billing (physician-side, not facility/UB-04) Demonstrated experience billing for Primary Care / Internal Medicine Experience billing hospital visits and SNF / nursing home visits (place of service 21, 31, 32) Advanced knowledge of CPT coding, ICD-10-CM, HCPCS Level II, and modifier usage Strong working knowledge of E/M coding guidelines (both 1995/1997 and 2021 revised guidelines) Hands-on eClinicalWorks (eCW) experience — mandatory Direct experience working with Medicare (Part B), Medicaid, and major commercial payers (BCBS, Aetna, UHC, Cigna) Experience with clearinghouses (Waystar, Change Healthcare, or similar) Experience managing denial workflows and submitting formal payer appeals Experience with provider credentialing, CAQH, and PECOS enrollment Ability to work independently and manage full RCM operations without close supervision

Preferred Qualifications CPC (Certified Professional Coder) or CPB (Certified Professional Biller) — AAPC credentialed Experience building a billing department or RCM function from scratch Experience supporting independent providers or solo/small group practices Experience with multi-location or multi-setting billing (clinic + hospital + SNF simultaneously) Strong analytical skills — ability to produce and interpret RCM KPI reports Familiarity with value-based care billing, chronic care management (CCM), and annual wellness visit (AWV) coding

Work Style & Culture Fit Hands-on operator — not just a manager Highly detail-oriented with strong documentation habits Proactive communicator with the provider and practice leadership Comfortable owning outcomes independently without heavy oversight Problem-solver who can troubleshoot payer issues, eCW configurations, and workflow bottlenecks Adaptable to a growing, fast-moving independent practice environment

Compensation & Details Remote

— Work from anywhere in the U.S. Full-Time Competitive salary based on experience and qualifications

To apply, send your resume and a brief note on your eClinicalWorks experience and payer background to: