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Industry: Software Development
Company Size: 11-50 employees

RemoteHunter

Savvy Admin PROD

1. About Our Client:The organization operates in the healthcare sector, focusing on physician enablement by collaborating with medical groups, health plans, and health systems. It addresses challenges in optimizing physician practices and improving patient care experiences by providing scalable operations and cloud-based technology. This approach aims to reduce unnecessary healthcare costs, improve patient outcomes, and enhance provider well-being.

2. About the Opportunity:The Medical Claims Billing Specialist (Athena) plays a key role in managing the accurate and timely processing of insurance claims within the revenue cycle. Reporting to the Associate Director of Revenue Cycle Management, this position ensures claims are reviewed, denied claims are appealed, and aged claims are followed up on. The role contributes to optimizing revenue cycle performance and supports communication between internal teams and physician practices.

3. Responsibilities:• Manage accounts receivable, including analyzing aged AR and identifying root causes of issues

• Investigate, resolve, and appeal insurance claim denials, including contacting payer representatives

• Make independent decisions on claim adjustments, resubmissions, and appeals

• Collaborate with Performance, Operations, Sales teams, and care center staff as needed

• Support care center go-lives, which may involve overnight travel

• Work with Revenue Optimization team to ensure reimbursements align with payer contracts

• Utilize denial analysis tools such as the Trizetto platform

• Coordinate directly with practice consultants or physicians to enhance revenue cycle functionality

• Aim to meet daily and monthly departmental Key Performance Indicators (KPIs)

• Perform other assigned duties

4. Requirements:• High school graduate

• Minimum 3 years of experience in medical billing or equivalent claims processing

• Knowledge of revenue cycle performance drivers and ability to resolve complex claims

• Advanced Microsoft Excel skills preferred (pivot tables, VLOOKUP, formulas)

• Experience with athenaHealth and/or athenaOne required

• Orthopedic medical claims billing experience preferred

• Experience with California payers and portals preferred

• Compliance with HIPAA regulations

5. Pay Range and Compensation Package:• Hourly base pay ranges from $24 to $26.45, excluding bonuses and benefits

• Eligible for an annual bonus targeted at 10%

• Base pay depends on experience, education, and location

6. Benefits & Perks:• Medical insurance

• Dental insurance

• Vision insurance

• Life insurance

• Pet insurance

• 401(k)

• Paid time off

• Wellness programs

Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.

Note:RemoteHunter is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company’s career page or ATS.

Medical Claims Billing Specialist (Athena)

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