Medical Biller & Collections Specialist - Freelance, Remote

Department: Support & LeadershipLocation: Global+Compensation: $9.00 / hourDescriptionAbout the ClientA nationally focused clinical specialty pharmacy that provides home infusion, specialty and compounding services with a strong emphasis on personalized, community-based care. The organization is accredited and operates with rigorous compliance and HIPAA standards while serving multiple states. They prioritize timely authorizations, clinical support, and high-quality billing/reimbursement practices to ensure patients receive home-based infusion therapies.Why does this role exist?This role exists to accelerate and stabilize revenue collection for home infusion services by managing insurance-side billing and out-of-network claim recoveries. The specialist will reduce accounts receivable backlog, resolve denials and underpayments, and negotiate reimbursements with payers so clinical teams can focus on patient care. Hiring this specialist ensures compliant, efficient collections and improved cash flow for infusion services.The Impact you’ll makeAccounts Receivable ManagementMonitor and manage patient and insurance accounts to ensure timely collection of outstanding balances.Review unpaid or partially paid claims, verify billing details, and follow up with payers to secure payment.Maintain accurate aging trackers and prioritize high-risk accounts.Billing and DocumentationReview claims for completeness and payer compliance before resubmission.Ensure accurate posting of payments, adjustments, and account notes in billing systems.Maintain detailed records of collection activities, insurance communications, and follow-ups.Out-of-Network Claims ManagementVerify coverage and eligibility for out-of-network claims, obtain necessary authorizations, and prepare documentation for reimbursement requests.Negotiate payment terms and reimbursements with insurance companies for out-of-network services.Manage balance-billing workflows and coordinate with internal teams to determine patient responsibility (note: role focuses on insurance-side collections; no direct patient outreach).Dispute Resolution & Denial ManagementInvestigate claim denials or underpayments, obtain supporting clinical/billing documentation, and submit appeals or corrections as required.Collaborate with pharmacy staff and payer representatives to resolve disputes and implement corrective actions.Track denial reasons and recommend process improvements to reduce recurrence.Reporting & CompliancePrepare regular AR, aging, and collections activity reports for management review.Analyze trends (denials, payer behavior, aging) and suggest optimizations to collection processes.Ensure all activities comply with HIPAA, payer policies, and internal billing best practices.Skills, Knowledge and ExpertiseRequired:Proven experience in medical billing and collections with direct experience managing out-of-network claims (home infusion pharmacy experience preferred).Strong knowledge of CPT and ICD-10 coding and payer requirements for infusion services.Proficiency with Caretend and CPR Plus (or equivalent billing systems) and strong Excel skills.Demonstrated experience negotiating with insurance companies and resolving denials/underpayments.Ability to work Monday–Friday, 9:00 AM–5:00 PM PST (40 hours/week) and maintain a HIPAA-compliant remote workspace.WFH Set-Up:Computer with at least 8GB RAM, an Intel i5 core processor/AMD Ryzen 5 Processor and up.Internet speed of at least 40MBPSHeadset with an extended mic that has noise cancellation and a webcamBack-up computer and internet connectionQuiet, dedicated workspace at homeYour Superpowers:Deep knowledge of medical billing workflows, claims submission, appeals, and payer negotiations.Proficient with Caretend, CPR Plus, MS Excel, Word, and Google Workspace.Familiarity with coding (CPT, ICD-10) and payer-specific documentation requirements. Soft skillsExcellent negotiation and written communication skills focused on insurer interactions.High attention to detail, organization, and ability to manage competing priorities.Problem-solver mindset and persistence in follow-up to drive collections.Integrity and strict adherence to HIPAA and privacy regulations.You should apply if...You enjoy investigative work and are motivated by resolving denials and recovering revenue.You are self-directed, reliable on a consistent PST schedule, and comfortable working remotely.You value compliance, clear documentation, and collaborative problem solving with clinical and operational teams.You’re patient, persistent, and able to negotiate professionally with payers without escalating to clinical teams unnecessarily.What to expect...Work Setup:Remote positionMust have a reliable internet connection and a quiet workspaceRequired to provide own computer with Intel Core i5 or something similar or higher operating systemWorking Hours:40 hours per weekMonday–Friday, 9:00 AM–5:00 PM Pacific TimeCompensation:$9 per hourNo benefits package includedBenefits