Claims/Billing Specialist

Professional Management Enterprises; United States; Remote; USD 40,000 - 70,000; Full time

Job summary

An established industry player is seeking a Claims/Billing Specialist to join their remote team. This role is critical in managing TRICARE Health Plan billing and ensuring compliance with healthcare regulations. You will be responsible for examining care records, preparing claims, and ensuring accurate payment posting. If you have a keen eye for detail and a strong background in medical billing, this is an excellent opportunity to make a significant impact in a supportive environment that values your expertise and dedication.

Qualifications

• Proven experience as a Medical Accounts Receivable Specialist.
• Familiarity with medical terminology and healthcare regulations.

Responsibilities

• Examine Admission and Discharge Episode of Care Records.
• Prepare, Code and File Claims, ensuring compliance with standards.

Skills

TRICARE Health Plan billing experience

Knowledge of billing procedures

Communication skills

Data entry skills

Attention to detail

Problem-solving ability

Education

High school diploma

Degree in Business Administration

Tools

MS Office

Medical coding software

Job description

Job Title: Claims/Billing Specialist

Hours: M-F 8a-5p

Location: Remote USA



**TRICARE Health Plan billing experience (Must have)



Duties:

Examine Admission and Discharge Episode of Care Records

Ensure Adequate Clinical Documentation

Verify Level of Care

Ensure Compliance with MLA Billing Procedures and Standards

Prepare, Code and File Claims

Track Claims Status, Approvals

Ensure EOB Accuracy

Ensure Accurate Payment Posting

Ensure Accurate Data Entry

Process Denials and Appeals

Perform such other and further duties as assigned by the MLA Revenue Cycle Director

Qualifications:

* Proven working experience as a Medical Accounts Receivable Specialist or similar role.

*TRICARE Health Plan billing experience (Must have)

* Knowledge of billing procedures and collection techniques

* Familiarity with medical terminology and healthcare regulations.

* Proficiency with MS Office and databases.

* Excellent communication and data entry skills.

* Attention to detail and problem-solving ability.

* Understanding of medical coding and billing software.

* High school diploma; degree in Business Administration or related field is a plus.