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Wellstar Health System
Wellstar Health System
HealthcareHealthcare Insurance
Wellstar Health System is a large healthcare organization serving patients and communities across Georgia and South Carolina. Founded in 1992, it provides healthcare services while bringing together a broad workforce across clinical, administrative, and operational roles. The organization’s careers focus includes opportunities in healthcare and healthcare insurance, with an emphasis on compassionate patient care, respect, inclusion, and community engagement.
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Remote Billing and Claims Specialist

Process electronic and paper healthcare claims for Wellstar Health System in a remote role serving payers and patients. Investigate edits, denials, eligibility issues, coding requirements, and billing discrepancies.

USUnited StatesRemoteFull-timeJuniorNo degree requiredEnglish RequiredClaims Specialist

Description

  • Prepare and submit accurate electronic and paper claims to third-party payers
  • Investigate claim edits and payer rejections, researching issues and resolving them independently
  • Review medical records and apply CMS requirements, CPT coding guidance, and departmental procedures
  • Monitor clearinghouse activity through Change Healthcare and resolve related support issues
  • Coordinate patient eligibility verification through external sources
  • Record and clarify billing activity in the patient accounting system
  • Resolve patient billing concerns while managing denial and insurance follow-up
  • Include required payer documentation and send paper claims by mail
  • Process adjusted, corrected, and rebilled claims
  • Correct payer rejections, ICN errors, Master File issues, retro-review matters, transfer queues, and other work queue errors
  • Review and override edits generated by external clearinghouse systems
  • Submit claims for Railroad Medicare
  • Recommend improvements to billing systems and processes
  • Protect patient confidentiality and privacy under HIPAA requirements
  • Communicate professionally with patients, families, colleagues, healthcare teams, HIM, Revenue Integrity, Patient Access, Patient Financial Services, and referral agencies
  • Participate in staff meetings, in-service training, and continuing education
  • Support special projects and performance improvement work
  • Keep required competencies current and follow Wellstar policies, work standards, and code of conduct

Requirements

  • High school diploma or GED
  • At least one year of medical billing experience, including familiarity with billing-related reporting
  • Experience working with Medicare, Medicaid, and commercial medical payers
  • Working knowledge of CPT and ICD-10 coding systems
  • Understanding of medical billing and collection practices
  • Consistent ability to meet deadlines and deliver results
  • Effective communication and customer service skills
  • Strong analytical ability and problem-solving skills
  • Excellent time management and ability to work independently
  • Knowledge of HIPAA guidelines and regulations
  • Ability to follow CMS requirements, CPT coding guidelines, departmental procedures, policies, and other regulatory standards
  • Ability to protect confidential information and patient privacy
  • Ability to work with patients and families from varied developmental and sociocultural backgrounds
  • Ability to use telephones, email, and other communication devices
  • Ability to work with Epic EMR, external claim-scrubbing edits, clearinghouse platforms, and patient accounting systems
  • Ability to process Medicare, Medicaid, commercial insurance, and Railroad Medicare claims

Benefits

  • Opportunity to contribute to meaningful work
  • Support for a more rewarding life
  • Staff meetings, in-service training, and continuing education
  • Participation in system-wide performance improvement initiatives
  • Supportive work environment
  • Full-time employment

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