GoTo Telemed is seeking a Remote Medical Biller to manage the full revenue cycle for a growing telehealth platform serving multiple medical specialties across the United States. The ideal candidate will handle end-to-end billing operations including eligibility verification, claims submission, payment posting, denial management, and accounts receivable follow-up, directly contributing to provider revenue and patient satisfaction.
What You'll Do
- Verify patient medical insurance eligibility and benefits prior to telehealth appointment scheduling using secure insurance verification portals and phone verification
- Confirm coverage details including deductibles, out-of-pocket maximums, copays, coinsurance, frequency limitations, and telehealth coverage status
- Identify medical necessity requirements, pre-authorization, and referral requirements; obtain all necessary approvals before service delivery
- Maintain accurate, current insurance information in practice management systems; update policies when changes occur
- Identify coverage gaps, exclusions (telehealth limitations, specialty exclusions, etc.), and conditions affecting billing and collections
- Document all verification activities and flag special requirements or coverage concerns for clinical and billing teams
- Ensure complete, accurate patient demographic and insurance data capture at appointment booking
- Validate patient information accuracy (name, date of birth, insurance policy numbers, group numbers, member IDs, etc.)
- Update patient records when insurance changes, policies renew, or coverage terminations occur
- Communicate patient financial responsibilities, copays, deductibles, and projected out-of-pocket costs before service delivery
- Capture patient consent for services and billing; document in compliance with HIPAA and state telehealth regulations
- Accurately code telehealth visits and medical services using Current Procedural Terminology (CPT) codes and appropriate modifiers
- Assign correct ICD-10-CM codes for all diagnoses documented in clinical notes
- Apply telehealth-specific modifiers (93 for audio-only, 95 for audio/video synchronous, GT, FQ, FR) in accordance with payer policies and CMS guidance
- Verify correct place of service (POS) coding for telehealth encounters (POS 02 for provider office, POS 10 for patient home, POS 11 for patient location as specified)
- Ensure complete charge capture and accurate medical necessity documentation; identify any missing information before claim submission
- Review clinical documentation for specificity (laterality, severity, complexity) and communicate coding queries to providers when documentation is insufficient
- Stay current with annual CPT/ICD-10 updates, new telehealth codes (98000-series), and payer-specific coding requirements
- Submit medical claims electronically through clearinghouses (837 EDI format) within 3-5 days of service delivery
- Prepare and manage claims via multiple submission pathways: electronic clearinghouse, direct payer portals, and print-to-mail for specific payers or situations
- Track all submitted claims with documentation of submission date, claim number, claim status, and clearinghouse identification
- Monitor claim status continuously; flag claims at risk of denial or delay for proactive follow-up
- Manage front-end claim edits and rejections; correct claim errors and resubmit within 24 hours
- Comply with all payer-specific requirements: claim format, documentation attachments, modifier usage, and submission deadlines
- Maintain detailed claim tracking logs for audit and reporting purposes
- Monitor outstanding claims daily; conduct systematic follow-up on all claims past 15, 30, 45, and 60 days
- Contact insurance companies via phone, email, and secure payer portals to obtain claim status, identify delay reasons, and resolve pending issues
- Review Explanations of Benefits (EOBs) and identify payment discrepancies, underpayments, or improper adjustments
- Send timely patient statements weekly for patient responsibility balances exceeding 30 days
- Follow up on patient balances through professional phone calls, patient statements, and secure messaging
- Implement systematic collection procedures for patient accounts 30+ days past due
- Negotiate payment plans and settlements with patients while maintaining professional, ethical communication
- Document all collection activities, patient communications, and payment arrangements in patient records
- Maintain compliance with Fair Debt Collection Practices Act (FDCPA) and state collection laws
- Analyze all claim denials and rejections; identify root causes (coding errors, missing documentation, eligibility issues, medical necessity, prior authorization gaps, etc.)
- Prepare corrected claims with necessary documentation changes; resubmit per payer guidelines
- Prepare formal written appeals for denied claims with supporting clinical documentation and policy justification
- Track appeal submissions and responses; resubmit appeals as needed until resolution
- Calculate impact of denials on provider revenue; prioritize high-value or recurring denials for focused remediation
- Maintain denial tracking reports to identify patterns by payer, code, diagnosis, or provider
- Implement process improvements to prevent recurrence of common denial reasons
- Identify underpayments and contractual adjustment errors; prepare documentation for recovery or credit adjustment
- Post insurance payments and Explanations of Benefits (EOBs) to patient accounts accurately and timely
- Reconcile posted EOBs with submitted claims and identify discrepancies, missing payments, or claim-to-claim variation
- Post patient payments from multiple sources: patient payments, payment plans, refund processing
- Apply payments to correct patient accounts and claim lines; maintain clear audit trail for all transactions
- Process contractual adjustments and write-offs per payer fee schedules and provider agreements
- Reconcile monthly insurance payments and EOBs with banking records; reconcile provider revenue reports
- Identify and resolve payment discrepancies, missing EOBs, and payment delays within 5 business days
- Identify claims, appeals, and patient statements requiring physical mail delivery per payer requirements
- Prepare documentation for printing and mailing; ensure compliance with HIPAA Privacy Rule requirements
- Maintain print-to-mail logs with tracking information and addresses
- Verify patient and provider mailing addresses; ensure HIPAA-compliant delivery
- Track delivery of critical documents using postal tracking when available and appropriate
- Generate daily claim processing reports (claims submitted, claims pending, claims approved)
- Produce weekly and monthly revenue cycle reports including: Days in Accounts Receivable (DAR) by payer
- Produce weekly and monthly revenue cycle reports including: Claim submission volume and claim approval rates
- Produce weekly and monthly revenue cycle reports including: Denial rates, denial reasons, and denial trends
- Produce weekly and monthly revenue cycle reports including: Patient collection rates and aging AR analysis
- Produce weekly and monthly revenue cycle reports including: Payment posting timeliness and payment discrepancies
- Produce weekly and monthly revenue cycle reports including: Clean claim rates (first-pass acceptance)
- Identify trends and process improvement opportunities; communicate findings to management
- Track Key Performance Indicators (KPIs) and compare performance against industry benchmarks
- Support management reporting and financial forecasting
What We're Looking For
- Expertise in medical coding (CPT, ICD-10-CM, HCPCS)
- Knowledge of telehealth modifiers
- Understanding of payer policies and compliance
- Ability to manage end-to-end billing lifecycle including patient eligibility verification, insurance claim submission, payment posting, accounts receivable follow-up, and denial management
Technical Stack
- Practice management systems
- Claims clearinghouses
- Coding software
- Automation tools
- Secure insurance verification portals
- Electronic data interchange (EDI) 837 format
- Direct payer portals
- HIPAA-compliant communication and documentation systems
- Postal tracking systems
Team & Environment
- Distributed RCM team
- Distributed team of medical billers, coders, and RCM specialists
- Reporting structure: not specified
Benefits & Compensation
- Unlimited Growth Opportunity
- Monthly Provider & Client Expansion: responsibilities and earning potential expand proportionally as new providers and specialties are added
- Scalability without Chaos: systematic processes, training, and resources ensure smooth scaling
- Career Advancement Path: Progress from Medical Biller → Senior Biller → RCM Team Lead → RCM Manager → Director of Revenue Operations
- Skill Diversification: Work with multiple medical specialties (primary care, cardiology, orthopedics, behavioral health, urgent care, etc.)
- Professional Training Programs: Formal onboarding, continuous education on CPT/ICD-10 updates, telehealth policy changes, and payer-specific requirements
- Certification Support: Full reimbursement for CPB, CPC, CCA, or other healthcare credentials; study time and exam fees covered
- Advanced RCM Technology: Access to best-in-class practice management systems, claims clearinghouses, coding software, and automation tools
- Expert Mentorship: Paired with experienced RCM professionals for guidance on complex coding scenarios, denial resolution, and process optimization
- Peer Collaboration: Regular team meetings, knowledge sharing, and collaborative problem-solving with a distributed team
- 100% Work-from-Home: Eliminate commuting; work from anywhere with reliable internet
- Flexible Schedule: Core hours 8 AM – 5 PM CST, with flexibility for medical appointments, personal needs, and work-life balance
- Home Office Support: $500 annual stipend for home office equipment, internet upgrades, and ergonomic setup
- Distributed Team Culture: Collaborate with colleagues across time zones; async communication tools support flexible scheduling
- Performance-Based Incentives: Earn bonuses based on claims processed, approval rates, AR reduction, and denial prevention
- Annual Raises & Reviews: Merit-based salary increases tied to performance, certifications, and expanded responsibilities
- Unlimited Earning Potential: Higher-volume processing, team oversight, and management roles with corresponding salary increases as provider network grows
- Transparent Compensation: Clear performance metrics and bonus structure; you always know how to increase earnings
Merit-based salary increases tied to performance, certifications, and expanded responsibilities; unlimited earning potential as provider network grows. Performance-based incentives (bonuses based on claims processed, approval rates, AR reduction, denial prevention), annual raises, and transparent bonus structure.
Work Mode
- 100% remote work; core hours 8 AM – 5 PM CST with flexibility for personal needs; async communication supported
GoToTelemed is an equal opportunity employer. We do not discriminate based on race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
