Job Summary

Aetna is seeking a detail-oriented and motivated Medical Billing Specialist to join our remote claims processing team. This role is essential to ensuring accurate and timely processing of healthcare claims, supporting both our providers and members. The ideal candidate will have a strong understanding of medical billing procedures, insurance policies, and compliance standards. This fully remote position offers the opportunity to work in a collaborative, supportive environment while making a meaningful impact on healthcare delivery.

Key Responsibilities

• Accurately process and review medical claims for payment or denial, ensuring compliance with internal policies and external regulations.

• Verify patient and provider information, including insurance eligibility and coverage.

• Resolve claim discrepancies and address denials by coordinating with providers, patients, and internal departments.

• Maintain accurate documentation of claims processing activities.

• Collaborate with cross-functional teams to ensure efficient claims operations and timely resolution of complex issues.

• Stay current on healthcare billing regulations, coding updates, and industry best practices.

• Identify process improvement opportunities to increase accuracy and efficiency.

Required Skills and Qualifications

• Proficiency in medical billing and coding, including CPT, ICD-10, and HCPCS codes.

• Strong knowledge of healthcare insurance policies, claim adjudication, and reimbursement processes.

• Excellent attention to detail and organizational skills.

• Effective written and verbal communication skills.

• Ability to analyze claim data and identify errors or discrepancies quickly.

• Comfort with remote work tools and technology, including claim processing software and Microsoft Office Suite.

Experience

• Minimum of 2 years of experience in medical billing, claims processing, or related healthcare operations role.

• Experience working with commercial and government insurance plans (Medicare, Medicaid) is highly desirable.

• Prior experience in a remote work environment is a plus.

Working Hours

• Full-time, Monday through Friday.

• Flexible schedule options may be available to accommodate different time zones.

Knowledge, Skills, and Abilities

• Ability to work independently while managing multiple priorities.

• Strong problem-solving skills and ability to escalate issues when necessary.

• High level of professionalism and ethical standards, especially regarding patient data and HIPAA compliance.

• Comfort adapting to new software, systems, and workflows.

Benefits

• Competitive salary with performance-based incentives.

• Comprehensive medical, dental, and vision coverage.

• 401(k) plan with company match.

• Paid time off, holidays, and wellness programs.

• Opportunities for professional development, training, and career advancement.

• Fully remote work flexibility with supportive virtual team environment.

Why Join Aetna?

At Aetna, we believe healthcare is a fundamental human right, and our mission is to help people achieve better health outcomes. Joining our team means contributing to a culture that values diversity, innovation, and collaboration. You will be part of an organization dedicated to making a real difference in the lives of members, providers, and communities, all while enjoying the flexibility and work-life balance of a remote position.

How to Apply

Interested candidates are encouraged to submit their resume and a cover letter through the Aetna careers portal: Aetna Careers
Please highlight your experience in medical billing, claims processing, and any relevant certifications. Qualified applicants will be contacted for the interview process.