Billing Specialist

Astrana Health•Las Vegas, NV

11h•$19 - $22•Hybrid

About The Position

We are seeking a highly organized, detail-oriented Billing Specialist to support accurate, timely, and compliant revenue cycle operations. This role plays a critical part in ensuring clean claim submission, efficient denial resolution, and optimal reimbursement across multiple payer lines of business. The ideal candidate thrives in a fast-paced healthcare environment, understands both front-end and back-end billing workflows, and is committed to accuracy, collaboration, and continuous process improvement. Experience with value-based care and risk-adjusted payment models is strongly preferred. This position directly supports our mission of improving patient outcomes while maintaining financial integrity within the healthcare system. Our Values Putting Patients First Operating with Integrity & Excellence Being Innovative Working as One Team

Requirements

High school diploma or equivalent required; billing certification (CPB, CMRS) or associate degree preferred.
Minimum 2+ years of medical billing experience in a multi-specialty or primary care environment.
Strong understanding of CPT, HCPCS, ICD-10 coding fundamentals, modifiers, and payer-specific billing rules.
Experience with Medicare Advantage, Medicaid Managed Care, HMO/PPO plans.
Experience using EMR/PM systems (eCW preferred).
Excellent organizational, time management, and communication skills.

Nice To Haves

Knowledge of risk adjustment, RAF/HCC coding relevance, and value-based care models preferred.

Responsibilities

Front-End Billing Review charges for completeness, compliance, and accuracy before claim submission.
Validate CPT, HCPCS, ICD-10 codes, modifiers, place of service, and provider information.
Confirm payer sequencing, insurance eligibility, demographics, and authorization requirements.
Create and submit clean claims in eCW using approved workflows.
Identify and correct missing or unsupported services prior to submission to prevent denials.
Perform comprehensive follow-up on outstanding claims by payer and aging bucket.
Investigate claim delays, denials, rejections, coding issues, and system errors.
Contact payers via portals and phone to resolve claim issues and document outcomes.
Submit corrected claims, appeals, and supporting documentation as needed.
Identify denial trends and communicate recurring barriers to leadership.
Support backlog clean-up initiatives and improvement in cash flow performance.
Maintain clear, complete documentation on 100% of touched claims including date/time, action taken, outcome, representative/contact reference, and next steps.
Follow eCW queue workflows and approved action/result codes.
Ensure claims do not remain inactive beyond three (3) business days.
Work closely with Coding, Credentialing, Payment Posting, Clinic Leadership, and RCM Management.
Escalate barriers promptly (payer issues, missing documentation, portal problems).
Assist with phone coverage and maintain excellent internal and external communication.
Maintain professionalism, respect, and a solution-focused approach in all interactions.
Maintain HIPAA compliance and protect PHI at all times.
Follow Astrana SOPs, payer policies, and revenue cycle workflows.
Uphold professionalism and courtesy in all interactions.