Remote Medical Billing & Claims Specialist

Cape Cod Healthcare Inc; Hyannis (MA); Remote; USD 45,000 - 65,000; Full time

Job summary

Cape Cod Healthcare Inc is seeking a Professional Billing and Claim Specialist for a remote role. You will bill healthcare claims to third-party payers, verify eligibility, and review submissions to ensure accuracy and HIPAA compliance.

You will analyze payer rejections, collaborate with clinical staff, and maintain familiarity with CPT, HCPCS, ICD-10-CM, modifiers, and related billing guidelines to support timely reimbursement and revenue cycle performance.

Qualifications

• Must read, write, and communicate in English.
• High School diploma or GED.
• (Preferred) Associate's or Bachelor's degree in Business, Healthcare Administration, or related field.
• Minimum of one year of experience in professional/physician medical billing, including electronic claim submission (EDI), clearinghouses, and payer portals.
• Working knowledge of CPT, HCPCS, ICD-10-CM coding conventions and modifiers.
• Medical terminology.
• Insurance billing guidelines.
• HIPAA regulations.
• Proficiency with Microsoft Excel, Word, and Outlook.
• Strong analytical, organizational, and problem-solving skills with attention to detail.
• (Preferred) Experience using Epic or comparable electronic billing software.

Responsibilities

• Prepare and submit HIPAA compliant claims to third-party payors through EDI systems and payer platforms.
• Review billing records for accuracy and compliance before submission.
• Analyze billing edit reports and payer rejection notifications; correct and resubmit claims promptly.
• Collaborate with clinical and administrative staff to resolve discrepancies and ensure accurate submissions.
• Maintain knowledge of CPT/HCPCS/ICD-10-CM coding and modifiers and update billing information as directed.
• Verify insurance information through eligibility checks and payer portals.
• Research and resolve unbilled accounts and claim edits.
• Investigate complex billing issues involving third-party and government payors.

Skills

English proficiency

Analytical skills

Attention to detail

Education

High School diploma or GED

Assoc./Bachelors preferred

Tools

Microsoft Excel

Microsoft Word

Microsoft Outlook

Epic (preferred)

Job description

Cape Cod Healthcare Inc is seeking a Professional Billing and Claim Specialist for a remote role. You will bill healthcare claims to third-party payers, verify eligibility, and review submissions to ensure accuracy and HIPAA compliance.

You will analyze payer rejections, collaborate with clinical staff, and maintain familiarity with CPT, HCPCS, ICD-10-CM, modifiers, and related billing guidelines to support timely reimbursement and revenue cycle performance.