Medical Claims Billing Manager (Pediatric Therapy) — Philippines | Remote | Full-Time

About the Role: We’re hiring an experienced Medical Claims Billing Manager to oversee end-to-end billing operations for a pediatric therapy organization serving families with young children. This role is responsible for ensuring clean, timely claims submission and payment posting, maintaining compliance, reducing denials, and improving collections—while building repeatable processes and managing a billing team as we grow.

A strong candidate will bring direct pediatric therapy billing experience (OT/PT/ST and ideally ABA) and be highly comfortable working inside Fusion Web Clinic / Ensora (FusionWebClinic) EMR. You’ll be expected to own outcomes, improve systems, and provide clear reporting to leadership.

Key Responsibilities:

Billing Operations & Team Oversight
• Lead day-to-day medical billing operations: claim creation, scrubbing, submission, follow-ups, appeals, and resolution.
• Build and manage workflows, checklists, and quality controls to ensure accuracy and speed.
• Oversee and coach billing specialists; assign work queues and enforce productivity/quality standards.
• Coordinate closely with scheduling/intake/authorization teams to prevent upstream billing errors.

Claims Management:
• Ensure timely submission of claims and rebilling/corrections as needed.
• Track and work denials to resolution; manage payer correspondence and appeals.
• Monitor payer rules, filing limits, modifier requirements, and documentation needs relevant to pediatric therapy.
• Identify root causes of denials and implement corrective actions (training, SOP updates, EMR workflow changes).

Payment Posting, AR & Collections:
• Oversee ERA/EOB posting, adjustments, and reconciliation.
• Own accounts receivable follow-up: aging, underpayments, recoupments, and disputed claims.
• Improve cash flow by optimizing AR cycles and follow-up cadence.
• Support patient balances where applicable (statements, refunds, payment plans coordination—based on company process).

Authorizations, Eligibility & Compliance Coordination:
• Ensure claims align with authorizations, correct coding, and payer requirements.
• Collaborate on eligibility verification processes and benefits accuracy to prevent avoidable denials.
• Maintain HIPAA compliance and consistent documentation handling.

Reporting & Performance Improvement:
• Produce weekly/monthly billing dashboards (clean claim rate, denial rate, days in AR, aging, collections, top denial reasons).
• Set targets, track progress, and present improvements and risks to leadership.
• Recommend process improvements and system enhancements within Ensora/FusionWebClinic.

Required Experience & Skills:
• 3+ years of medical billing experience with at least 2+ years specifically in pediatric therapy billing (OT/PT/ST required; ABA a plus).
• Proven experience managing billing workflows and owning outcomes (AR reduction, denial resolution, improved collections).
• Strong working knowledge of Fusion Web Clinic / Ensora EMR (highly important).
• Strong understanding of claim lifecycle, payer processes, EOB/ERA posting, and denial management.
• Familiarity with pediatric therapy-related coding concepts (e.g., common therapy CPT codes, modifiers, units, place of service)—without needing constant supervision.
• Excellent attention to detail, organization, and accountability.
• Strong written English for payer follow-up, appeals, and internal documentation.

Nice to Have:
• Experience billing across multiple payer types (commercial, Medicaid/Medi-Cal, regional programs, school contracts, etc.).
• Experience supervising a remote billing team and building SOPs/training materials.
• Experience improving EMR billing setups (fee schedules, claim rules, templates, charge capture workflows).
• Basic Excel/Google Sheets proficiency for reporting and reconciliation.

What Success Looks Like (First 60–90 Days):
• Billing workflow stabilized with clear daily/weekly cadence and accountability.
• Improved clean-claim rate and faster denial resolution.
• AR visibility: accurate reporting by aging, payer, and denial reason.
• FusionWebClinic/Ensora workflows optimized to reduce errors and rework.
• A scalable plan for hiring/training additional billing support as volume grows.

Work Setup & Compensation:
• Remote (Philippines-based)
• Full-time with overlap hours for collaboration (CST or PST time zone)
• Competitive pay based on experience

How to Apply:

Please submit:
1. Resume/CV
2. A short cover letter describing your pediatric therapy billing experience (OT/PT/ST required)
3. Confirm your level of experience with Fusion Web Clinic / Ensora (years used, what you handled inside the system)
4. Optional but helpful: sample metrics you’ve improved (denial rate, AR days, collections), and how

?

If you want, I can also create a billing manager scorecard and a skills check tailored to pediatric therapy + Ensora/FusionWebClinic (including a denial-work scenario, aging analysis, and SOP-building exercise).