Job Title

Senior Medical Biller (eClinicalWorks Required) Remote | Full-Time | Independent Physician PracticeAbout OptiClaim Business SolutionsOptiClaim Business Solutions LLP is a specialized healthcare revenue cycle management and staffing firm operating across India and U.S. markets. We partner with independent physicians and small-to-mid-size practices to build high-performance billing operations — from credentialing and coding through collections and compliance. We are currently expanding our U.S. client portfolio and seeking a seasoned RCM professional to take full ownership of a physician billing account.Role OverviewWe are seeking a Revenue Cycle Manager / Senior Medical Biller to lead the complete professional billing function for an independent physician practice operating across outpatient clinic, hospital, and skilled nursing facility (SNF) / nursing home settings.This is not a supervisory-only role. The right candidate is a working RCM lead — someone who can independently manage charge entry, coding review, claim submission, AR follow-up, denial management, credentialing, and reporting, while building out a scalable billing department over time.Strong, hands-on experience with eClinicalWorks (eCW) is mandatory. Candidates without eCW experience will not be considered.Key ResponsibilitiesRevenue Cycle & Billing OperationsManage the full professional billing lifecycle: charge capture → charge entry → claim scrubbing → electronic claim submission → ERA/EOB posting → AR follow-up → denial management → collectionsEnsure timely and accurate claim submission for all service lines: primary care / outpatient clinic, hospital visits (inpatient and outpatient), nursing home / SNF visits, procedures, labs, and diagnostic interpretationsMonitor accounts receivable (AR) aging, track days in AR, and resolve outstanding claims proactivelyMaintain clean claim rates and minimize denial rates through front-end and back-end billing controlsManage payer-specific billing rules, fee schedules, and contract terms for Medicare, Medicaid, and commercial payersCoding & Documentation ReviewReview provider documentation and assign accurate CPT codes, ICD-10-CM diagnosis codes, and applicable modifiersValidate E/M level selection for office visits (99202–99215), hospital visits (99221–99223, 99231–99233), nursing home visits (99304–99310), and discharge servicesEnsure procedure coding compliance for in-office procedures, preventive services, lab orders, and diagnostic interpretationsIdentify documentation gaps and work directly with the provider to correct or addend clinical notesMaintain coding compliance with CMS guidelines, payer LCD/NCD policies, and OIG standardseClinicalWorks (eCW) Billing ManagementManage all billing workflows inside eClinicalWorks: charge entry, claim scrubbing, claim submission, and rejection workqueuesPost insurance payments, patient payments, contractual adjustments, and write-offsWork claim edits and clearinghouse rejections through eCW and the integrated clearinghouse (e.g., Waystar, Change Healthcare)Run and analyze billing reports, productivity reports, and payer performance reports inside eCWMaintain and update fee schedules, payer setups, referring provider data, and place-of-service configurationsOptimize billing workflows and workqueue management to improve throughput and reduce lag timePayer Relations & AR Follow-UpConduct proactive AR follow-up on all outstanding claims across Medicare, Medicaid (state), and commercial payersUse payer portals (Navinet, Availity, Emdeon, payer-direct portals) for real-time claim status, remittance review, and appeal submissionsManage denial root cause analysis (RCA) — identify patterns in denials by payer, denial reason code, and service typeWrite and submit formal appeals with supporting clinical documentation, medical necessity letters, and payer-specific appeal formsTrack and resolve coordination of benefits (COB), timely filing, authorization, and medical necessity denialsMaintain low AR days outstanding and report aging metrics to leadership on a regular cadenceCredentialing & Provider EnrollmentManage initial provider credentialing and re-credentialing with Medicare (PECOS), Medicaid (state MACs), and commercial health plansMaintain and update provider CAQH ProView profile and ensure attestation is currentComplete payer enrollment applications, follow up on pending enrollments, and resolve enrollment-related billing holdsEnsure provider is actively enrolled and linked at all billing locations (clinic NPI, hospital NPI, SNF NPI)Track credentialing expiration dates, DEA renewals, state license renewals, and malpractice certificatesReporting & ComplianceProduce monthly RCM performance dashboards: gross charges, net collections, collection rate, denial rate, days in AR, and payer mix analysisMonitor for HIPAA compliance in all billing, coding, and data handling workflowsStay current on CMS annual updates (CPT, ICD-10, RBRVS fee schedule, MPFS, E/M guideline revisions)Flag compliance risks and assist in implementing corrective action plans (CAPs) as neededTeam Leadership (Growth Phase)Assist in recruiting, onboarding, and training medical billers, coders, and AR specialists as the department growsBuild standard operating procedures (SOPs), workqueue management protocols, and QA checklists for the billing teamConduct productivity and quality audits on billing staffServe as the operational lead for all revenue cycle functionsRequired QualificationsMinimum 5 years of experience in medical billing and revenue cycle managementMinimum 2–3 years in a senior biller, lead biller, billing supervisor, or RCM manager roleStrong experience in professional fee billing (physician-side, not facility/UB-04)Demonstrated experience billing for Primary Care / Internal MedicineExperience billing hospital visits and SNF / nursing home visits (place of service 21, 31, 32)Advanced knowledge of CPT coding, ICD-10-CM, HCPCS Level II, and modifier usageStrong working knowledge of E/M coding guidelines (both 1995/1997 and 2021 revised guidelines)Hands-on eClinicalWorks (eCW) experience — mandatoryDirect experience working with Medicare (Part B), Medicaid, and major commercial payers (BCBS, Aetna, UHC, Cigna)Experience with clearinghouses (Waystar, Change Healthcare, or similar)Experience managing denial workflows and submitting formal payer appealsExperience with provider credentialing, CAQH, and PECOS enrollmentAbility to work independently and manage full RCM operations without close supervisionPreferred QualificationsCPC (Certified Professional Coder) or CPB (Certified Professional Biller) — AAPC credentialedExperience building a billing department or RCM function from scratchExperience supporting independent providers or solo/small group practicesExperience with multi-location or multi-setting billing (clinic + hospital + SNF simultaneously)Strong analytical skills — ability to produce and interpret RCM KPI reportsFamiliarity with value-based care billing, chronic care management (CCM), and annual wellness visit (AWV) codingWork Style & Culture FitHands-on operator — not just a managerHighly detail-oriented with strong documentation habitsProactive communicator with the provider and practice leadershipComfortable owning outcomes independently without heavy oversightProblem-solver who can troubleshoot payer issues, eCW configurations, and workflow bottlenecksAdaptable to a growing, fast-moving independent practice environmentCompensation & DetailsRemote — Work from anywhere in the U.S. Full-Time Competitive salary based on experience and qualificationsTo apply, send your resume and a brief note on your eClinicalWorks experience and payer background to: