Billing Specialist Medical Claims

Billing Specialist with Excel

Location: Remote

Duration: Long term contract with contract to hire option after 3 month

Pay: $25-$27/HR W2

Position Overview

The 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 Management

• Receive 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.

Claims Resolution

• 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.

Payment Processing

• Post claim payments manually when required.

• Prepare and submit invoices through electronic or non-electronic methods to ensure timely processing and payment.

Communication & Support

• Answer provider calls regarding claim issues.

• Present findings and communicate claim issues clearly to providers.

• Assist with process improvements and operational efficiencies.

Additional Duties

• Perform other duties as assigned to support claims operations.

EDI File Types Managed in This Role

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 Skills

• Strong 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

Qualifications

• High School Diploma or equivalent required

• Up to 1 year of relevant experience in claims processing, healthcare administration, or data operations preferred

Working Conditions

• Remote home office-based work environment

Supervisory Responsibility

None

Disclaimer

The 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.