Billing and Claims Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Prepare and submit accurate electronic and paper claims to third-party payers.

• Analyze, investigate, and independently resolve claim submission edits and payer denials.

• Gather information from medical records and apply CMS regulations, CPT coding standards, and departmental protocols.

• Follow up with Change Healthcare clearinghouse and address any support issues.

• Coordinate patient eligibility processes through third-party resources.

• Document and clarify billing activities within the patient accounting system.

• Identify and resolve patient billing challenges while managing denials and insurance follow-ups.

• Attach necessary documentation required by payers and send out paper claims.

• Issue adjusted, corrected, and rebilled claims as needed.

• Resolve payer rejections, ICN claim errors, Master File errors, retro-review issues, transfer work queues, and miscellaneous work queue errors.

• Review and override edits from external clearinghouses.

• Complete submissions for Railroad Medicare claims.

• Identify opportunities for improvements in systems and processes.

• Uphold patient confidentiality and privacy in compliance with HIPAA regulations.

• Communicate in a professional manner with patients, families, peers, healthcare teams, HIM, Revenue Integrity, Patient Access, Patient Financial Services, and referral agencies.

• Attend staff meetings, in-services, and ongoing education sessions.

• Assist with special projects and initiatives aimed at performance improvement.

• Maintain required competencies and adhere to Wellstar policies, standards of work, and the code of conduct.

⛳️ Requirements

• High School Diploma / GED.

• At least 1 year of experience in medical billing, including familiarity with billing-related reporting.

• Experience with medical payers such as Medicare, Medicaid, and commercial insurance.

• Proficient understanding of CPT and ICD-10 coding systems.

• Knowledge of medical billing and collection practices.

• Ability to meet deadlines and maintain a results-oriented approach.

• Strong communication and customer service skills.

• Excellent problem-solving and analytical abilities.

• Strong time management skills and the ability to work independently.

• Familiarity with HIPAA guidelines and regulations.

• Ability to adhere to CMS rules and regulations, CPT coding guidelines, departmental policies and procedures, and regulatory standards.

• Commitment to maintaining confidentiality and patient privacy.

• Ability to interact with patients and families from diverse developmental and sociocultural backgrounds.

• Proficient in using telephone, email, and other communication tools.

• Experience with Epic EMR, external claim scrubber edits, clearinghouse systems, and patient accounting systems.

• Capability to handle claims work involving Medicare, Medicaid, commercial insurance, and Railroad Medicare.

🏝️ Benefits

• Support to engage in more meaningful work.

• A more rewarding life.

• Participation in staff meetings, in-services, and ongoing education.

• Involvement in system performance improvement initiatives.

• A supportive work environment.

• Full-time employment.