Remote Medical Billing Specialist

AAPC; Spring Valley (NV); Hybrid; USD 52,000 - 65,000; Full time

Benefits offered by this job

Work from home option

Job summary

AAPC is seeking a detail-oriented Medical Billing Specialist with strong experience in medical billing, coding, and insurance processes. The role emphasizes accurate coding (ICD-10, CPT, HCPCS), knowledge of medical terminology, and collaboration with patients and payers to ensure timely reimbursement.

The role involves using EHR/EMR systems (Epic, Meditech, PrognoCis) for documentation and billing workflows, generating cost estimates, resolving denials, submitting appeals, and staying current

Qualifications

• High school diploma or equivalent required; Associate's degree preferred.
• CPC or CCS certification strongly preferred.
• Minimum of 2 years in medical billing, coding, and EHR/EMR systems.

Responsibilities

• Process and submit medical claims to insurers and third-party payers.
• Code using ICD-10, CPT, and HCPCS standards.
• Generate cost estimates based on insurance coverage and contracts.
• Verify billing data accuracy in EHR/EMR prior to submission.
• Use EHR/EMR systems (Epic, Meditech, PrognoCis) for billing workflows.
• Research and resolve billing discrepancies or denials.
• Prepare and submit insurance appeals per payer guidelines.
• Communicate billing questions to patients; explain coverage and responsibilities.
• Stay updated on medical terminology, payer rules, and HIPAA/CMS regulations.
• Collaborate with clinical staff to ensure accurate coding and documentation.
• Track accounts receivable and follow up on outstanding claims.

Skills

Attention to detail

Communication skills

Problem solving

Organizational skills

Education

High school diploma

Associate's degree preferred

CPC certification

CCS certification

Tools

Epic

Meditech

PrognoCis

Job description

We are seeking a detail-oriented and experienced Medical Billing Specialist with a strong background in medical billing, coding, and insurance processes. The ideal candidate will be skilled in medical terminology, procedure coding, cost estimation, insurance appeals, and working within electronic health record systems. This role requires accuracy, excellent communication skills, and the ability to work with both patients and payers to ensure timely and correct reimbursement.

This position may offer the opportunity to work from home, depending on experience and performance.

Key Responsibilities:

• Accurately process and submit medical claims to insurance companies, government payers, and other third-party organizations.
• Perform medical coding using ICD-10, CPT, and HCPCS standards for a variety of procedures and diagnoses.
• Generate and communicate cost estimates for procedures based on insurance coverage and contract agreements.
• Review and verify accuracy of billing data within EHR/EMR systems prior to claim submission.
• Utilize EHR/EMR platforms (such as Epic, Meditech, PrognoCis) for documentation, coding, and billing workflows.
• Research and resolve billing discrepancies or claim denials.
• Prepare and submit insurance appeals, ensuring compliance with payer guidelines.
• Communicate with patients regarding billing questions, payment responsibilities, and insurance coverage.
• Maintain up-to-date knowledge of medical terminology, payer requirements, and compliance regulations (HIPAA, CMS, etc.).
• Collaborate with clinical staff and providers to ensure accurate coding and documentation within electronic systems.
• Track accounts receivable and follow up on outstanding claims to maximize revenue.

Requirements

Qualifications:

• High school diploma or equivalent required; Associate's degree in Healthcare Administration, Billing & Coding, or related field preferred.
• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification strongly preferred.
• Minimum of 2 years of experience in medical billing, coding, insurance follow-up, and working within EHR/EMR systems.
• Strong knowledge of ICD-10, CPT, and HCPCS coding systems.
• Hands-on experience with electronic health record (EHR) and electronic medical record (EMR) systems, including Epic, Meditech and/or PrognoCis.
• Familiarity with medical terminology, payer reimbursement guidelines, and healthcare regulations.
• Experience creating cost estimates for medical procedures.
• Skilled in preparing and submitting appeals for denied claims.
• Proficiency with medical billing software and electronic health record (EHR) systems.
• Strong attention to detail, problem-solving, and organizational skills.
• Excellent written and verbal communication skills.

Preferred Skills:

• Experience with Medicare/Medicaid billing and commercial insurance.
• Advanced knowledge of EHR/EMR workflows and system navigation.
• Ability to work independently and manage multiple tasks in a fast-paced environment.
• Customer service experience in a healthcare setting.