Specialist, Billing

Ovation Healthcare•Crest, CA

4d•$45,094 - $67,641•Remote

About The Position

The Specialist, Billing manages daily billing operations to ensure timely, accurate, clean claims, reviews claims, resolves daily claim edits, and ensures compliance with insurance billing policies and regulations. The role prepares and submits claims for patient services, reviews patient accounts and remittance advice, reconciles payments with secondary payers, and ensures outstanding balances are addressed before secondary claims are filed. It also maintains accurate claim documentation, supports compliance with CMS regulations, HIPAA, and company policies, and helps address account issues with internal departments. The specialist assists management in maintaining or reducing accounts receivable days and meeting assigned productivity and quality standards. The position is 100% remote. The work-from-home setup requires a stable internet connection, a quiet and dedicated workspace, and necessary office equipment. The role requires regular communication with team members, management, and clients through email, phone, video meetings, and other collaborative tools. Travel is not required.

Requirements

Proven experience in third-party insurance billing, collections, or patient accounts, preferably in healthcare.
In-depth knowledge of billing codes, guidelines, and regulations.
Familiarity with electronic health record systems, billing software, and remittance advice processing.
Strong communication skills, including the ability to explain Medicare billing details and resolve patient concerns.
Ability to handle sensitive information and maintain confidentiality in accordance with HIPAA.
Detail-oriented, with strong organizational skills and the ability to manage multiple accounts simultaneously.
Problem-solving ability, particularly with 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.
High school diploma or equivalent.
Ability to work remotely with a stable internet connection, a quiet and dedicated workspace, and necessary office equipment.
Ability to communicate daily with team members, management, and clients using email, phone, video meetings, and other collaborative tools.
Ability to sit at a desk for extended periods.

Nice To Haves

Medical terminology, ICD-10, CPT, and DRG knowledge.
Knowledge of third-party insurance payer guidelines.
Additional training in medical billing.

Responsibilities

Manage daily billing and ensure claims are timely, accurate, and clean.
Review claims and resolve daily claim edits.
Maintain a list of payer split-billing requirements, update the team crosswalk, and monitor payer changes.
Use payer portals for appeal uploads and provide feedback to the internal team when needed.
Import claims from the host system into the claims processing system when required.
Prepare and submit accurate claims for patient services in compliance with third-party payer guidelines and regulations.
Review patient accounts, reconcile payments with secondary payers, review remittance advice, and ensure payments are posted correctly.
Address outstanding balances before filing claims with secondary payers.
Ensure billing and collection practices comply with CMS regulations, HIPAA, and company policies.
Maintain accurate claim records and proper documentation in the patient account system.
Meet assigned daily productivity and quality standards.
Work with patient financial services, finance, billing, and other internal departments to address issues or disputes affecting patient accounts.
Assist management in maintaining or reducing accounts receivable days to meet industry standards and improve organizational cash flow.

Benefits

Medical, dental, vision, and life insurance.
Short- and long-term disability coverage.
Health savings account with employer contributions.
Flexible spending accounts for health care and dependent care.
Wellness platform with premium incentives.
Employee assistance support.
Voluntary supplemental plans, including accident, critical illness, hospital indemnity, and child disability insurance.
Flexible paid time off offerings and company-paid holidays.
401(k) plan with discretionary employer match opportunities.
Professional development opportunities.
Company-issued equipment.