Pediatric Medical Biller Denials & A/R Follow-Up | Permanent WFH

We are seeking an experienced Pediatric Medical Biller – Denials & A/R Follow-Up to manage denied, rejected, and unpaid claims while supporting the financial health of a busy pediatric practice.

The ideal candidate has strong hands-on experience in pediatric medical billing, denial management, insurance follow-up, and accounts receivable (A/R), with proven proficiency in eClinicalWorks (eCW). This role requires someone who can investigate claim issues, communicate confidently with insurance carriers, submit corrected claims and appeals, and consistently follow up until outstanding balances are resolved.

Key Responsibilities

• Manage and follow up on denied, rejected, and unpaid pediatric claims.
• Review claims and denial information to identify root causes and determine the appropriate resolution.
• Contact insurance carriers by phone and through payer portals to verify claim status and resolve outstanding issues.
• Submit corrected claims, reconsiderations, appeals, and supporting documentation as required.
• Monitor and work assigned A/R based on aging, outstanding balance, payer requirements, and timely filing deadlines.
• Review EOBs and ERAs to identify denial reasons, underpayments, payment discrepancies, and additional follow-up requirements.
• Resolve billing issues related to eligibility, authorizations, coding, timely filing, coordination of benefits, medical necessity, and payer-specific requirements.
• Maintain accurate documentation of claim activity, payer communications, follow-up actions, and resolutions in eClinicalWorks (eCW).
• Coordinate with clinical and administrative teams when additional information or documentation is required to resolve claims.
• Maintain consistent follow-up on outstanding accounts to maximize reimbursement and minimize aging A/R.
• Identify recurring denial trends and communicate potential billing issues to the appropriate team.
• Escalate complex or unresolved claims when additional intervention is required.
• Maintain strict patient confidentiality and comply with HIPAA, payer regulations, and practice policies.
  
  

Qualifications

• 2+ years of medical billing experience, preferably within a pediatric practice or pediatric healthcare setting.
• Strong experience in denial management, insurance follow-up, and A/R collections.
• Hands-on experience with eClinicalWorks (eCW) is required.
• Experience communicating directly with insurance carriers and payer representatives.
• Strong understanding of the medical billing, claims, and insurance reimbursement process.
• Experience reviewing EOBs, ERAs, claim denials, corrected claims, appeals, and payer portals.
• Working knowledge of commercial insurance and Medicaid billing; pediatric billing experience preferred.
• Strong understanding of claim submission requirements, timely filing, eligibility, authorizations, coordination of benefits, and payer guidelines.
• Excellent attention to detail and ability to identify discrepancies and billing errors.
• Strong written and verbal communication skills.
• Excellent organization and time-management skills.
• Ability to independently manage a high-volume A/R workload and prioritize accounts effectively.
• Experience working directly with pediatric practices or pediatric specialty clinics.
• Familiarity with common pediatric insurance plans and Medicaid requirements.
• Experience handling complex or recurring claim denials.
• Strong knowledge of payer websites and electronic claim systems.
• Ability to analyze A/R trends and identify opportunities to improve collections.
• Comfortable working independently in a remote or fast-paced environment.
  
  

Perks

• Permanent Work From Home
• Leave Credits
• Monetary Allowance
• Annual Bonus
• Weekly Paychecks
• Fixed Weekends Off
• Thriving Company Culture with Complete Autonomy
• Exclusive Specialized Training Programs
• Unlock Your Potential with a Highly Competitive Salary
  
  

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Who are we

BizForce is one of the fastest-growing global outsourcing companies in the world, founded in the US in Tucson, Arizona and is now operational in PH!

Our Commitment to delivering high-quality results for our clients and the only way to do that is ensuring a rewarding, respectful and productive experience for our employees. We hold the same values for both our customers and our employees.