Medical Billing Specialist (CCM/APCM)

About the role

A growing Revenue Cycle Management (RCM) team is looking for an experienced Medical Billing Specialist to manage the end-to-end billing process for US healthcare providers, with a focus on Chronic Care Management (CCM) and Advanced Primary Care Management (APCM) programs. Claims must be accurate, submitted on time and compliant with Medicare and payer guidelines, and the specialist works with providers, insurers and internal teams to resolve billing issues and reduce denials.

Key responsibilities

• Prepare, review and submit accurate claims for CCM and APCM services to Medicare, Medicare Advantage and commercial payers.
• Verify patient insurance eligibility, benefits and coverage before submission, and confirm consent, care plans and program enrollment are in place.
• Review monthly CCM time logs so billed time matches the CPT code (e.g. 99490, 99439, 99487, 99489).
• Bill APCM services under the correct monthly HCPCS G-codes by patient complexity level, and ensure CCM and APCM are not billed together for the same patient in the same period.
• Enter charges, payments and adjustments accurately in the billing system.
• Follow up on denied or rejected claims through appeals, corrections and timely resolution, and help reduce accounts receivable aging.
• Coordinate with insurers, clinics and care teams on billing discrepancies, keep billing records in the practice management system, and stay current with CMS guidelines and payer policies.

Required profile

• 3 to 4 years of hands-on experience in US medical billing or revenue cycle management.
• Good understanding of CCM and/or APCM billing, or similar Medicare care management programs such as RPM or TCM.
• Experience managing claim denials, including root cause analysis, appeals, resubmissions and AR follow-up.
• Ability to handle high claim volumes while meeting productivity and quality targets.
• Preferred: certification in medical billing (e.g. CPB), direct CCM/APCM billing experience, and experience with US healthcare providers or medical billing companies.

Required skills

• Strong knowledge of Medicare billing rules; familiarity with ICD-10, CPT and HCPCS codes.
• Eligibility verification, pre-authorizations and claim processing for commercial and government payers.
• Practice management systems, EHR platforms and Microsoft Excel.
• Analytical skills, attention to detail and good written and verbal communication.