Billing Specialist

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

📋 Description

• Oversee daily billing processes to ensure claims are accurate, timely, and well-organized.

• Examine claims and address daily claim edits while adhering to insurance billing policies and regulations.

• Maintain split billing requirements according to payer specifications and update the team crosswalk for any changes.

• Submit appeals via payer portals and provide constructive feedback to the internal team.

• Import claims from the host system into the claims processing system as necessary.

• Prepare and submit precise claims for patient services in alignment with third-party payer guidelines and regulations.

• Review patient accounts, reconcile payments with secondary payers, and process remittance advice accordingly.

• Verify that payments are posted accurately and that outstanding balances are resolved prior to filing with secondary payers.

• Ensure compliance with CMS regulations, HIPAA standards, and company policies.

• Keep accurate claims records and maintain proper documentation within the patient account system.

• Achieve assigned daily productivity and quality benchmarks.

• Collaborate with patient financial services, finance, and billing departments to resolve patient-account issues and disputes.

• Support management in minimizing accounts receivable days and enhancing organizational cash flow.

⛳️ Requirements

• Demonstrated experience in third-party insurance billing, collections, or patient accounts, ideally in a healthcare environment.

• Comprehensive understanding of billing codes, guidelines, and regulations.

• Familiarity with electronic health record (EHR) systems, billing software, and remittance advice processing.

• Excellent communication skills, particularly in explaining Medicare billing details and addressing patient inquiries.

• Capable of handling sensitive information and maintaining confidentiality under HIPAA regulations.

• Detail-oriented with strong organizational capabilities and proficiency in managing multiple accounts concurrently.

• Problem-solving skills related to billing discrepancies and denied claims.

• Experience using payer portals, client systems, and clearinghouse requirements.

• 3–5 years of experience as a primary biller in a hospital business office setting.

• Knowledge of medical terminology, ICD-10, CPT, DRG, and third-party insurance payer guidelines.

• High school diploma or equivalent required.

• Prior experience with California payers is preferred.

🏝️ Benefits

• Opportunity to work from home and remote locations.

• Stable internet connection, a quiet and dedicated workspace, and necessary office equipment will be provided.

• Daily communication via email, phone calls, video meetings, and collaborative tools.

• No travel is required.