Location: Remote
Duration: Long term contract with contract to hire option after 3 month
Pay: $25-$27/HR W2
Position OverviewThe Billing Specialist supports healthcare claims operations by managing electronic data files processing claim submissions monitoring claim status and assisting providers with resolving claim issues. This role requires strong attention to detail analytical thinking and the ability to work effectively with providers clearinghouses and internal teams to ensure timely claims processing and payment.
Key Responsibilities Claims Processing & Data ManagementReceive and import weekly electronic client service data files from multiple locations.
Process claim submission files and submit claims to multiple payers and clearinghouses.
Upload and process EDI transaction files (999 277 and 835) from multiple sources for tracking reconciliation and payment status review.
Monitor claim status and research claims in detail to identify issues or discrepancies.
Work with providers to correct and resubmit rejected or denied claims.
Respond to provider inquiries related to claims processing.
Follow up with Accounts Receivable teams to ensure claims are processed and paid.
Post claim payments manually when required.
Prepare and submit invoices through electronic or non-electronic methods to ensure timely processing and payment.
Answer provider calls regarding claim issues.
Present findings and communicate claim issues clearly to providers.
Assist with process improvements and operational efficiencies.
Perform other duties as assigned to support claims operations.
The Claims Processing Specialist works with common healthcare Electronic Data Interchange (EDI) files:
EDI 999 Functional acknowledgment confirming whether a submitted file was accepted or rejected
EDI 277 Claim status response indicating claim processing status
EDI 835 Electronic remittance advice detailing claim payment information
These files are uploaded reviewed and tracked to ensure accurate claim processing and payment reconciliation.
Required SkillsStrong organizational quantitative and analytical skills
Excellent attention to detail and accuracy
Strong problem-solving abilities
Ability to prioritize tasks and manage multiple assignments
Ability to work both independently and collaboratively in a team environment
Effective communication skills when working with providers and internal teams
Adaptability when priorities shift
Experience using Microsoft Office products particularly Excel
High School Diploma or equivalent required
Up to 1 year of relevant experience in claims processing healthcare administration or data operations preferred
Remote home office-based work environment
None
DisclaimerThe above description is intended to describe the general content and requirements of work performed by individuals assigned to this position. It is not intended to be an exhaustive list of all duties responsibilities or skills required.