Medical Claims Billing Specialist

About Sailor Health: At Sailor Health, we envision a world where every senior has seamless access to compassionate, effective, and personalized mental health care. We are on a mission to redefine the golden years, enabling older adults across the nation to live happier, healthier, and more fulfilling lives with dignity and connection.

Role Summary

We are seeking a highly execution-driven Medical Claims Billing Specialist to support our growing Revenue Cycle Management (RCM) operations. This full-time role sits at the intersection of operations, billing, and payer management, focusing entirely on ensuring medical claims are submitted accurately, worked quickly, and reimbursed efficiently. Your daily efforts will directly impact our financial health and guarantee that our senior patients can continue accessing critical care without interruption.

Key Responsibilities

• Claims Submission & Tracking: Accurately and efficiently submit medical claims to Medicare and commercial insurance payers, while actively monitoring aging accounts.
• Denials Management: Review, track, and proactively follow up on denied, rejected, unpaid, or stale claims to ensure maximum reimbursement limits.
• Error Resolution & Appeals: Identify and resolve eligibility issues, authorization gaps, claim errors, and payer rejections; swiftly submit corrected claims and manage formal appeals.
• Payer Relations: Work directly with insurance companies and clearinghouses to resolve complex billing and reimbursement blockers.
• Cross-Functional Collaboration: Partner closely with internal intake, credentialing, clinical, and operations teams to resolve claim blockers and ensure seamless collections.
• Workflow Optimization: Maintain precise documentation in internal systems and help optimize billing workflows to improve claim turnaround times.

Required Skills & Qualifications

• Prior professional experience working in U.S. healthcare billing, Revenue Cycle Management (RCM), or insurance claims follow-up and denials management (Absolutely Mandatory).
• Experience working directly with Medicare and commercial insurance payer systems is strongly preferred.
• Deep structural understanding of claims submission processes, denials management, appeal cycles, and payer follow-up workflows.
• Hands-on experience using Electronic Health Records (EHRs), medical billing systems, clearinghouses, or digital insurance portals.
• Extremely detail-oriented and highly organized, capable of handling high-volume operational work with speed and accuracy.
• Strong written and verbal English communication skills .
• Employment Restriction: This is a strict full-time commitment. No other concurrent jobs or freelance engagements are allowed.
• Location Context: 100% remote working flexibility strictly open to qualified professionals residing in the Philippines .

What We Offer

• Monthly Compensation: $1,200 – $1,500 USD per month (final rate determined based on specific experience levels and interview performance).
• 100% remote work flexibility within a mission-driven, highly supportive team.
• An agile startup environment where you will take ownership, shape key operational processes, and grow alongside the company.
• The opportunity to perform meaningful work that directly supports older adults and their families.