Role Overview
No Nights, Weekends, Holidays
We are seeking a dedicated Medical Billing Specialist to serve in a dual-function role at our WI facility. You will serve as the on-site point of contact for our Medicare 855B site inspection process and support our Care Management Billing team.
This position is currently 5 days per week, on-site at 444 Reid Street, De Pere, WI 54115. As our clinical program scales and staffing grows, a hybrid schedule (rotating in-office and remote days) will become available. That transition will be communicated in advance with clear expectations.
Physical presence during the 10:00 AM to 2:00 PM - Monday through Friday (FT or Multiple PT to cover). Our facility is subject to unannounced CMS / MAC site inspections as part of a pending 855B application. A missed inspection results in automatic application denial. Punctuality and consistency are non-negotiable in this role.
On-Site Responsibilities
Medicare Site Inspection Compliance
- Serve as the sole dedicated physical presence at the facility during all posted operating hours.
- Act as the immediate, professional point of contact when a MAC field inspector arrives unannounced.
- Escort inspectors through the facility and respond to operational questions factually and without elaboration.
- Confirm each morning that the facility is open, utilities are operational, and equipment is functioning before 10:00 AM.
- Verify that external business signage is visible and in compliance.
- Maintain strict physical HIPAA compliance, including locked medical records storage and secured server areas.
- Maintain the Readiness Binder at the front desk at all times, containing:
- Active state facility licenses
- IRS CP-575 forms
- Current building lease
- Copy of the submitted 855B application
Medical Billing Specialist – Care Management
The Medical Billing Specialist supports the day-to-day revenue cycle operations for Medicare and commercial care management programs, including Chronic Care Management (CCM), Principal Care Management (PCM), and Remote Patient Monitoring (RTM). This role is responsible for accurate data entry, claim reconciliation, billing support, and identifying claim or documentation issues to ensure timely and compliant reimbursement for our provider partners.
This position works closely with internal operations, compliance, customer success, and provider offices to resolve billing issues, reconcile claims, and support revenue cycle performance.
Primary Responsibilities
- Perform accurate data entry of care management encounters and billing information.
- Reconcile monthly care management services prior to claim submission.
- Review billing reports to identify missing documentation, coding discrepancies, and claim variances.
- Research denied, rejected, or unpaid claims and assist with resolution.
- Perform detailed claim analysis and revenue cycle "deep dives" to identify trends and opportunities for process improvement.
- Support provider clients with billing questions and reconciliation requests.
- Validate patient eligibility and payer requirements as applicable.
- Assist with monthly billing audits and quality assurance reviews.
- Collaborate with compliance and operations teams to ensure documentation supports billed services.
- Maintain organized billing records and tracking spreadsheets.
- Participate in ongoing training sessions, team meetings, and workflow improvement initiatives.
- Maintain strict confidentiality and comply with all HIPAA and company privacy policies.
- Perform additional revenue cycle, billing, and administrative duties as assigned.
Preferred Experience
- Medical billing and revenue cycle experience in a physician practice..
- Prior authorization experience is helpful but not required.
- Experience working claim denials, payment posting, reconciliations, or accounts receivable is a plus.
- Familiarity with electronic health records (EHRs) and practice management systems.
Qualifications
- High school diploma or equivalent required.
- Medical Billing and Coding certification (CPC, CCA, CBCS, CMRS, or equivalent) preferred but not required.
- Minimum of 2–3 years of medical billing, coding, revenue cycle, or healthcare administrative experience preferred.
Key Competencies
- Strong organizational and time management skills.
- Ability to analyze billing trends and identify root causes of claim issues.
- Excellent written and verbal communication skills.
- Ability to manage multiple priorities in a fast-paced environment.
- Commitment to accuracy, compliance, and exceptional customer service.
Technical Requirements
- Proficiency with Zoom, Slack, and online patient enrollment platforms.
- Personal laptop with a working microphone, camera, and reliable internet connection.
- Quiet, dedicated workspace available for remote work when the hybrid schedule is introduced.
Professional Attributes
- Calm, articulate, and professional conduct when interacting with federal auditors or healthcare officials.
- Excellent verbal and written communication skills with an emphasis on empathy and patient support.
- Strong organizational skills and the ability to manage multiple simultaneous responsibilities.
- Ability to work independently and take initiative without close supervision.
- Demonstrated commitment to HIPAA compliance and patient privacy.
Preferred Clinical Background
Candidates with experience in any of the following specialties are strongly preferred:
- Orthopedics
- Physical and Rehabilitation Medicine
- Sports Medicine
- Neurology
What We Offer
- Contractor position at $20.00 to $22.00 per hour, negotiable based on experience.
- A path toward a hybrid schedule as the clinical program grows and staffing expands.
- Opportunities for professional growth within a Series B technology-driven healthcare company.
- A direct, collaborative team culture that values precision, ownership, and patient outcomes.
Pay: $20.00 - $22.00 per hour
Work Location: Hybrid remote in De Pere, WI 54115
