Billing Specialist II - REMOTE

Overview

This role involves processing and auditing insurance claims, rebilling denied claims, and resolving billing discrepancies within an electronic claims management system. The Billing Specialist II ensures accurate and timely claim submission, identifies and corrects billing errors, and maintains compliance with payer regulations and organizational policies. The position requires advanced knowledge of billing procedures, coding standards, and third-party payer requirements, and includes mentoring junior billing staff.

Responsibilities

• Process and submit insurance claims via electronic and paper billing systems, ensuring accuracy, completeness, and compliance with payer-specific requirements.
• Review patient demographics, balances, and insurance information prior to claim generation, making necessary corrections.
• Identify and resolve claim errors, denials, and rejections; take corrective action and rebill claims within required timeframes.
• Monitor electronic billing processes to ensure successful claim downloads, accurate transmission, and timely follow-up on failed claims.
• Audit and assemble billing documentation, reviewing claims for completeness and applying modifications to ensure proper reimbursement.
• Demonstrate proficiency in revenue codes, HCPCS, CPT coding, and payer billing guidelines to ensure accurate claims processing and regulatory compliance.
• Respond to billing inquiries from internal departments and payers, providing resolution within two business days or escalating issues as needed.
• Maintain knowledge of third-party billing regulations, payer requirements, and automated resources to improve billing efficiency and compliance.
• Assist in mentoring and training junior billing staff, sharing expertise in claim resolution, billing requirements, and payer policies.
• Communicate with patient access, revenue cycle, and coding teams to ensure accurate billing information and prevent claim errors.
• Perform other duties as assigned.
• Maintain regular and reliable attendance.
• Comply with all organizational policies and standards.

Qualifications

• High School Diploma or GED required.
• Associate Degree in Business, Healthcare Administration, Medical Billing, or related field preferred.
• 2-4 years of experience in medical billing, insurance claims processing, or revenue cycle operations required.
• Experience with hospital or physician billing, including payer policies, reimbursement processes, and electronic billing systems preferred.

Knowledge, Skills, and Abilities

• Advanced understanding of insurance claim processing, billing regulations, and reimbursement methodologies.
• Proficiency in electronic claims management systems, revenue codes, and medical coding standards (HCPCS, CPT, UB-04, CMS-1500).
• Strong problem-solving skills with the ability to analyze claim errors, identify trends, and implement corrective actions.
• Experience with payer-specific guidelines, denial management, and appeals processes.
• Ability to work independently and mentor junior billing staff, demonstrating leadership and teamwork.
• Proficiency in Microsoft Office Suite (Excel, Outlook, Word) and electronic health record (EHR) systems.
• Strong written and verbal communication skills for interacting with payers, internal departments, and external partners.

Licenses and Certifications

• Certified Professional Biller (CPB) preferred.

Compensation and Benefits

• Comprehensive health coverage including medical, dental, and vision plans.
• 401(k) retirement plan with matching contributions.
• Student loan repayment assistance up to $10,000.
• Educational tuition assistance.
• Competitive salary and full benefits package designed to reward expertise and dedication.

Location

Position is based at a medical center in North Knoxville.