Job Description
**Job Summary**
The Remote Medical Billing Specialist is responsible for processing, auditing, and submitting primary and secondary insurance claims, ensuring accuracy, compliance, and timely reimbursement. This role utilizes electronic claims management systems to review, correct, and resolve billing errors, denials, and rejections. The Billing Specialist I collaborates with internal teams, facility liaisons, and payers to ensure clean claim submission and adherence to federal, state, and payer-specific regulations.
**Essential Functions**
+ Processes and submits primary and secondary insurance claims accurately and in a timely manner, ensuring compliance with payer guidelines and regulatory requirements.
+ Reviews and resolves claim errors, rejections, and denials, making necessary corrections and resubmitting claims as needed.
+ Demonstrates working knowledge of billing forms, including UB-04, CMS-1500, or state-specific billing forms, ensuring claims are submitted with the appropriate documentation.
+ Audits claims for accuracy, checking for duplicate charges, overlapped accounts, and missing information before submission.
+ Investigates and processes rebill requests, verifying claim accuracy and making necessary updates per facility or coding liaison direction.
+ Maintains knowledge of billing regulations, payer policies, and electronic submission guidelines, staying up to date with federal, state, and local billing requirements.
+ Utilizes electronic billing systems to analyze, research, and transmit claims, ensuring proper documentation of actions taken in the collection system.
+ Monitors and reports charging or edit trends, collaborating with internal teams (such as coding, patient access, and ancillary departments) to improve billing accuracy.
+ Performs daily balancing tasks using SSI and other billing systems, escalating unresolved issues or billing delays to the Billing Services Manager.
+ Communicates professionally with payers, facility representatives, and internal teams, ensuring efficient issue resolution and proper follow-up on outstanding claims.
+ Performs other duties as assigned.
+ Complies with all policies and standards.
**Qualifications**
+ H.S. Diploma or GED required
+ Associate Degree in Business, Healthcare Administration, Medical Billing, or a related field preferred
+ 0-1 years of experience in medical billing, insurance claims processing, or revenue cycle operations required
+ 1-3 years of billing experience in a medical facility, ambulatory surgery facility, or acute-care preferred
+ Experience with hospital or physician billing, including knowledge of payer policies and electronic claims systems preferred
**Knowledge, Skills and Abilities**
+ Basic understanding of insurance claim processing, medical billing, and reimbursement guidelines.
+ Familiarity with billing software, electronic claims management systems (e.g., SSI, Pulse/DAR), and eligibility tools.
+ Knowledge of CMS, Medicaid, Medicare, and commercial insurance billing regulations.
+ Ability to analyze and resolve claim errors, denials, and rejections efficiently.
+ Strong attention to detail, organizational skills, and ability to meet deadlines.
+ Proficiency in Microsoft Office Suite (Excel, Outlook, Word) and electronic health record (EHR) systems.
+ Excellent communication and problem-solving skills, with the ability to interact professionally with internal teams and external payers.
Equal Employment Opportunity
This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment. This applies to all terms and conditions of employment including, but not limited to: hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to to obtain the main telephone number of the facility and ask for Human Resources.
Job Tags
Local area,
Similar Jobs
CBRE
ElectricianJob ID208383Posted05-Mar-2025Service lineGWS SegmentRole typeFull-timeAreas of InterestEngineering/MaintenanceLocation(s)San Jose - California - United States of America**ABOUT THE ROLE**As a CBRE Electrician, you will inspect, repair, and maintain...
Robert Half
Description We are looking for a talented Production Artist to join our team on a contract basis in Irvine, California. This role involves contributing to high-impact projects during a busy event season, with a focus on creating large-scale display graphics and marketing...
Gordon Food Service
...driving? Are you looking for more home time? Picture yourself as a delivery driver with Gordon Food Service! In this position, you will be... ...restaurants, schools, hospitals, universities, and more. Day shifts and local routes mean youll be home every day. Youll be required to...
Jacobs Management Group, Inc.
...Step into a role where your regulatory expertise helps bring life-enhancing medical technologies to market. My client is seeking a driven Senior Regulatory Affairs Associate to support U.S. and global submissions for innovative devices developed in Carlsbad, CA. Your work...
Nautical Ventures
...tenders up to Yachts. NV has a broad and expansive selection of boats from your everyday Center console boats to you mid-sized Yacht to... ...different styled boats, we may be the right fit for you. The Sales Consultant is responsible for selling boats through consistent customer...