Billing Specialist

Billing Specialist

Department: Billing

Employment Type: Full Time

Location: 8880 W Sunset Rd, Suite 320, Las Vegas NV 89148

Reporting To: Lydia Allred

Compensation: $19.00 - $22.00 / hour

We are seeking a highly organized, detail-oriented Billing Specialist to support accurate, timely, and compliant revenue cycle operations. This role plays a critical part in ensuring clean claim submission, efficient denial resolution, and optimal reimbursement across multiple payer lines of business.

The ideal candidate thrives in a fast-paced healthcare environment, understands both front-end and back-end billing workflows, and is committed to accuracy, collaboration, and continuous process improvement. Experience with value-based care and risk-adjusted payment models is strongly preferred.

This position directly supports our mission of improving patient outcomes while maintaining financial integrity within the healthcare system.

• Putting Patients First
• Operating with Integrity & Excellence
• Being Innovative
• Working as One Team

• Review charges for completeness, compliance, and accuracy before claim submission.
• Validate CPT, HCPCS, ICD-10 codes, modifiers, place of service, and provider information.
• Confirm payer sequencing, insurance eligibility, demographics, and authorization requirements.
• Create and submit clean claims in eCW using approved workflows.
• Identify and correct missing or unsupported services prior to submission to prevent denials.

• Perform comprehensive follow-up on outstanding claims by payer and aging bucket.
• Investigate claim delays, denials, rejections, coding issues, and system errors.
• Contact payers via portals and phone to resolve claim issues and document outcomes.
• Submit corrected claims, appeals, and supporting documentation as needed.
• Identify denial trends and communicate recurring barriers to leadership.
• Support backlog clean-up initiatives and improvement in cash flow performance.

• Maintain clear, complete documentation on 100% of touched claims including date/time, action taken, outcome, representative/contact reference, and next steps.
• Follow eCW queue workflows and approved action/result codes.
• Ensure claims do not remain inactive beyond three (3) business days.

• Work closely with Coding, Credentialing, Payment Posting, Clinic Leadership, and RCM Management.
• Escalate barriers promptly (payer issues, missing documentation, portal problems).
• Assist with phone coverage and maintain excellent internal and external communication.
• Maintain professionalism, respect, and a solution-focused approach in all interactions.

• Maintain HIPAA compliance and protect PHI at all times.
• Follow Astrana SOPs, payer policies, and revenue cycle workflows.
• Uphold professionalism and courtesy in all interactions.

• High school diploma or equivalent required; billing certification (CPB, CMRS) or associate degree preferred.
• Minimum 2+ years of medical billing experience in a multi-specialty or primary care environment.
• Strong understanding of CPT, HCPCS, ICD-10 coding fundamentals, modifiers, and payer-specific billing rules.
• Experience with Medicare Advantage, Medicaid Managed Care, HMO/PPO plans.
• Experience using EMR/PM systems (eCW preferred).
• Knowledge of risk adjustment, RAF/HCC coding relevance, and value-based care models preferred.
• Excellent organizational, time management, and communication skills.

• This role begins with a minimum of 8 weeks fully onsite for training at our office located at 8880 W Sunset Rd, Suite 320, Las Vegas, NV 89148. After onboarding and demonstration of consistent performance, employees may be considered for a hybrid schedule based on productivity and business needs.
• Scheduling options: 7:30 AM – 4:00 PM or 8:00 AM – 4:30 PM with a 30-minute lunch between 12:00–1:00 PM.
• The total compensation range for this role is $19–$22/hour. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.

Astrana…