Medical Billing Executive

XenMD, a US-focused healthcare services company specializing in medical billing, revenue cycle management (RCM), credentialing, prior authorization, denial management, and practice support, is seeking a detail-oriented Medical Billing Executive. This full-time position is based in Rawalpindi / Bahria Town, Pakistan, working night shifts aligned with US healthcare hours. The role involves managing end-to-end medical billing and revenue cycle activities for US healthcare clients, ensuring accuracy, timely claim submissions, and effective denial management.

Key Responsibilities

- Perform comprehensive medical billing and revenue cycle management, including reviewing patient demographics, insurance, and provider information for accuracy.
- Enter charges based on medical documentation and submit electronic and paper claims to commercial, Medicare, Medicaid, and Medicare Advantage payers.
- Verify insurance eligibility and benefits, monitor claim acceptance and rejection reports, and promptly correct and resubmit rejected claims.
- Track claim status, follow up with insurance companies, and resolve claim processing issues.
- Analyze insurance denials, rejections, and underpayments; identify root causes and prepare corrected claims or appeals.
- Conduct regular accounts receivable (AR) follow-up on unpaid, partially paid, and denied claims within payer timelines.
- Post insurance and patient payments accurately, including contractual adjustments, write-offs, deductibles, copays, and coinsurance.
- Reconcile Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs) with posted payments, identifying discrepancies.
- Utilize payer portals for eligibility verification, claim submission, status checks, and communication with insurance representatives.
- Coordinate with providers and client practices to obtain missing information such as medical records, authorizations, and referrals.
- Maintain accurate billing and AR records, prepare weekly and monthly reports, and monitor key RCM metrics like clean claim rate, denial rate, days in AR, and collection rate.
- Conduct quality checks to minimize billing errors and meet assigned productivity and quality targets.
- Communicate effectively with clients and internal teams regarding claim issues, status updates, and outstanding matters.

Required Qualifications

- 1 to 3+ years of experience in US medical billing or healthcare revenue cycle management.
- Strong knowledge of US healthcare insurance processes, including Medicare, Medicaid, Medicare Advantage, and commercial insurance.
- Familiarity with claim submission, rejection and denial management, and AR follow-up.
- Understanding of EOBs, ERAs, CPT, HCPCS, ICD-10, modifiers, and place of service (POS) codes.
- Experience working with payer portals and managing multiple client accounts.
- Excellent attention to detail and ability to identify billing discrepancies.
- Good written and verbal communication skills.
- Strong organizational and time-management abilities.
- Proficiency in Microsoft Excel and basic office tools.
- Ability to work independently and maintain professional communication with US healthcare clients and insurance companies.

Preferred Qualifications and Benefits

- Experience with medical billing software or EHR/PM systems such as Athenahealth, Tebra, Office Ally, SimplePractice, Kareo, AdvancedMD, eClinicalWorks, NextGen, or RXNT.
- Background in specialties including Primary Care, Behavioral Health, ABA, Mental Health, Physical Therapy, Home Health, Cardiology, OBGYN, Dermatology, Pain Management, or other outpatient specialties.
- Knowledge of medical coding and payer-specific billing requirements.
- Experience handling appeals, complex denials, and high-volume claims and AR.
- Competitive salary based on experience and qualifications.
- Opportunities for professional growth, training, and development.
- Performance-based incentives and career advancement within XenMD.
- Exposure to multiple US healthcare specialties.

The successful candidate will be expected to maintain high billing accuracy, submit claims within required timelines, reduce avoidable denials, maintain thorough documentation, and uphold HIPAA and company confidentiality standards. This is an in-person role offering a competitive salary range of Rs45,000 to Rs75,000 per month.