Medical Billing Specialist

ST. ELIZABETH MANAGEMENT GROUP
Revenue Cycle Management • Position Description

RCM Billing Specialist – Virtual Assistant (Philippines)

Position Title RCM Billing Specialist – Virtual Assistant
Employment Type Full-Time, Remote (Philippines-based)
Reporting To SEMG RCM Team Lead
Hours Monday – Friday, 8:00 AM – 5:00 PM CST (Houston time zone)
Compensation Competitive; commensurate with experience and qualifications
English Requirement C2 Proficiency (CEFR) – mandatory, non-negotiable
Target Start Upon SEMG RCM Team Lead hire and onboarding (est. 30–60 days)


About St. Elizabeth Management Group
St. Elizabeth Management Group (SEMG) is a Houston-area healthcare management company overseeing revenue cycle operations across a portfolio of physician groups and specialty practices. SEMG is currently executing a strategic consolidation of billing operations — absorbing functions previously distributed across multiple external vendors and entity-level staff into a centralized, high-performance internal RCM team.

The entities within scope include a primary care / ACO-affiliated physician group, a telehealth platform delivering Remote Patient Monitoring (RPM), Chronic Care Management (CCM), and Principal Care Management (PCM), and a multi-site urgent care group with active Workers’ Compensation billing operations. These are not startup practices — combined gross monthly charges exceed $400,000, and this team will be accountable for protecting and improving that revenue.


Role Overview
SEMG is hiring two RCM Billing Specialists to serve as the operational core of its newly centralized revenue cycle team. These are not administrative assistant roles. You will execute hands-on medical billing across multiple EHR systems and payer portals, manage denial workflows, support claims submission and AR follow-up, and operate with a high degree of accuracy and autonomy under the direction of the SEMG RCM Team Lead.

You will work with real patients’ claims, real payer timelines, and real financial consequences. The team being built is small, which means individual performance is visible and impactful. Candidates who thrive in high-accountability, detail-intensive environments with clear metrics will succeed here. Candidates who need significant hand-holding or who treat billing as a data-entry function will not.


Core Responsibilities
Claims Submission & Charge Entry
• Review and submit claims across multiple EHR platforms (Athena, eClinicalWorks, Agility)
• Verify charge capture accuracy, including CPT/ICD-10 code pairing and modifier application
• Apply correct Place of Service (POS) codes based on service delivery context (critical for RPM/CCM billing)
• Confirm patient eligibility and insurance verification prior to claim submission
• Identify and correct coding errors prior to initial submission to minimize first-pass denials

Denial Management & Appeals
• Monitor payer remittances (ERAs) and identify claim denials by reason code
• Categorize and track denials by payer, code, and denial type in designated tracking systems
• Draft and submit written appeals with supporting clinical or coding documentation
• Conduct follow-up calls to payer provider relations lines when written appeals are insufficient
• Escalate complex or high-dollar denials to the RCM Team Lead with a documented summary

Accounts Receivable Follow-Up
• Work AR aging queues on a defined weekly cycle; prioritize by dollar value and timely filing deadlines
• Contact payers via portal and telephone to resolve claims in pending, processing, or suspended status
• Identify patterns in delayed or underpaid claims and report to Team Lead with supporting data
• Document all follow-up activity with date, contact name, and outcome in the billing system

Workers’ Compensation Billing Support
• Submit WC claims to employer and TPA payers per applicable state fee schedule requirements
• Support employer invoicing workflows including charge reconciliation against spreadsheet-tracked accounts
• Monitor WC claim status and follow up with adjusters as directed by Team Lead
• Maintain clean separation of WC AR from commercial/Medicare AR in reporting

RPM / CCM / PCM Billing Compliance
• Apply correct CPT codes for Remote Patient Monitoring (99453, 99454, 99457, 99458) and Chronic Care Management (99490, 99491) services
• Verify that time logs and device data thresholds meet billing criteria before claim submission
• Monitor for POS and modifier combinations that affect reimbursement on telehealth-delivered services
• Flag any RPM/CCM claims that fail enrollment or documentation criteria prior to submission

Reporting & Documentation
• Maintain accurate records of claim status, denial activity, and follow-up in the RCM tracking system
• Provide weekly AR aging summaries to Team Lead in the required format
• Document payer-specific billing rules and exceptions as discovered, for team reference
• Participate in regular team calls with the SEMG RCM Team Lead (video, CST hours)


Requirements & Qualifications

Requirement Type Notes
C2 English Proficiency (CEFR) Required Must be able to draft written payer appeals and conduct verbal follow-up calls without language barriers
Minimum 3 years U.S. medical billing experience Required Must be U.S. payer system, not international
Denial management & appeals experience Required Passive claim monitoring is not sufficient; must have active appeal experience
CPT / ICD-10 coding knowledge Required Applied coding accuracy, not general familiarity
ERA / EOP reading & reconciliation Required Must be able to interpret and act on remittance data without guidance
Experience with Athena, eClinicalWorks, or Agility EHR Preferred Any one of the three is sufficient; all three is a strong advantage
RPM / CCM / PCM billing experience Preferred Particularly codes 99453, 99454, 99457, 99490
Workers’ Compensation billing experience Preferred Texas WC system preferred; any U.S. WC experience considered
Multi-payer environment experience (Medicare, Medicaid, MA plans, Commercial) Required Single-payer background is insufficient for this role
Professional certification (CPC, CPB, CBCS, or equivalent) Preferred Not required; strong practical track record may substitute
Reliable high-speed internet and professional home office setup Required Video calls and EHR portal access are daily requirements
Availability during CST business hours (8 AM – 5 PM, M–F) Required No overlap exceptions; this is a synchronous team


Who You Are
You hold yourself to a standard that most people would find exhausting. You notice a denial reason code that doesn’t match the clinical documentation, and you investigate rather than accept it. You know the difference between a denial you can appeal and one that reflects a billing error on your end, and you treat them differently. You don’t let AR sit because a payer is slow — you call them.

You are comfortable working independently across multiple EHR systems without someone watching over your shoulder. You understand that in a small, centralized team, your accuracy directly affects physician cash flow. That fact motivates you rather than intimidates you.

Your English is strong enough to write an appeal letter that reads like it was written by a U.S. biller, because payer reviewers read hundreds of appeals and notice the ones that are vague or awkward. You are precise in writing, organized in your AR queues, and direct in your communication with your Team Lead.


What to Expect
This is a consolidation-phase hire. SEMG is building this team from scratch, which means processes, templates, and workflows will need to be developed alongside day-to-day billing operations. The first 90 days will require adaptability — you will be working with three different EHR systems, two or more payer portals, and billing profiles that have not always been well-managed.

You will report directly to the SEMG RCM Team Lead, who is also a new hire. Expect close collaboration as the team establishes its operating cadence. Performance expectations are real: collection rates, denial rates, and AR aging will be tracked from day one. This is not a role where performance is evaluated informally once a year.

On the other side of this ramp: you will be part of a lean, well-compensated team with direct visibility to leadership, clear metrics, and genuine upside in terms of role stability and growth as SEMG scales its managed entities. There is no bureaucratic layer between this team and decisions. If you see a billing problem, you report it and it gets addressed.


Performance Expectations

Metric 90-Day Target 12-Month Target
First-pass claim acceptance rate ?95% per assigned entity ?97?nial follow-up (within timely filing) 100% — no unworked denials 100% maintained
AR > 90 days (as % of total AR) Baseline established; trending down