Remote Medical Billing Specialist at PedsOne | Apply Now

Medical billing in specialized healthcare requires precision, regulatory knowledge, and a deep understanding of patient care workflows. PedsOne, a leader in pediatric-focused practice management, is actively recruiting for a Remote Medical Billing Specialist.

This comprehensive guide breaks down the core responsibilities, mandatory qualifications, remote technical prerequisites, benefit structures, and application steps for prospective candidates evaluated under standard revenue cycle management protocols.

About PedsOne

PedsOne operates out of Winooski, Vermont, providing specialized revenue cycle management (RCM) and practice management solutions exclusively designed for private pediatric practices. Unlike generalized medical billing agencies, PedsOne focuses entirely on the unique nuances of pediatric care—ranging from vaccine tracking and well-child visit coding to complex Medicaid reimbursement rules.

By partnering directly with practice managers, providers, and clinical staff, PedsOne helps pediatricians maintain financial sustainability so they can focus on delivering high-quality healthcare to children.

Position Overview: Remote Medical Billing Specialist

The Medical Billing Specialist is responsible for delivering top-tier billing services to private pediatric practice clients across the country. The role requires handling the entire life cycle of insurance claims, resolving complex payment discrepancies, posting payments, and managing patient communications regarding coverage.

While local candidates near the headquarters in Winooski, VT, are invited to work in a hybrid capacity (3 days in office, 2 days remote), this posting specifically invites candidates residing out of state or outside a reasonable commuting range for a 100% remote work arrangement.

Key Job Responsibilities

Medical Billing Specialists at PedsOne manage claim execution, payment reconciliation, and provider support across multiple fronts:

1. Claims Management & Coding Precision

• System Mastery: Learn and become highly proficient in Physician’s Computer Company (PCC) Billing, the premier pediatric-specific electronic health record (EHR) and billing system in the industry.

• Claim Review & Submission: Analyze insurance claims throughout the submission workflow to ensure accurate coding, timely processing, optimal reimbursement, and full regulatory compliance.

• Coding Rule Enforcement: Utilize proper ICD-10-CM, CPT, and HCPCS coding rules, along with Medicare’s National Correct Coding Initiative (NCCI) edits, to prevent claim rejections.

2. Denial Management & Claims Resolution

• Payer Oversight: Ensure all claims successfully reach insurance payers and independently manage any issues that arise during processing.

• CARC & Denial Analysis: Utilize Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC) to analyze underpayments, late payments, and claim denials.

• Payer Portal Navigation: Research payer-specific policies, coverage guidelines, and fee schedules by navigating online payer portals and insurance documentation.

3. Financial Reconciliation & Patient Communications

• Payment Posting: Accurately post insurance and patient payments, balance ledgers, and manage the dispatch of patient billing statements and correspondence.

• Inquiry Handling: Professionally answer telephone inquiries from patients and guarantors regarding benefit coverage, balance explanations, and payment arrangements.

• Client Consultation: Consult regularly with practice managers, front-desk operations staff, and healthcare providers to implement quality assurance measures, maintain optimal billing workflows, and ensure client satisfaction.

Candidate Qualifications & Skill Requirements

To succeed in this role, applicants must meet specific professional standards and technical competencies.

Minimum Required Qualifications

• Experience: Minimum of 4 recent years of specialized medical billing experience focused on physician services.

• Denials & CARC Knowledge: Demonstrated expertise in insurance payment posting, claim denial resolution, and interpreting CARC codes.

• Research Capabilities: Proven skill in navigating online insurance portals to analyze rules, guidelines, and medical policies.

• Clinical Understanding: A solid working knowledge of general medical terminology, basic human anatomy, and physiological concepts.

• Software Competency: Demonstrated comfort with modern computer technology and established proficiency (or ability to rapidly achieve proficiency) in Google Workspace (G-Suite) tools, including Gmail, Google Drive, Docs, Sheets, and Meet.

• Self-Management: Proven ability to self-manage, prioritize competing tasks, maintain strict attention to detail, and manage time efficiently in an independent workspace.

Preferred Qualifications & Ideal Characteristics

• Speciality Experience: Prior experience in pediatric or primary care billing environments.

• Remote Track Record: Proven history of successfully working in an independent, remote capacity.

• Coding Credentials: Professional medical coding certification from accredited bodies, such as an AAPC Certified Professional Coder (CPC) designation.

• Coding Frameworks: In-depth knowledge of pediatric coding guidelines, preventive care coding, and NCCI edit rules.

• Work Ethic: A natural balance of processing speed, quality control, and procedural accuracy under deadline conditions.

Remote Work & HIPAA Compliance Standards

Because this role involves accessing Protected Health Information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA), remote team members must maintain specific technical standards.

1. Workspace Security

Remote employees must maintain a private, distraction-free workspace that ensures client confidentiality and complies strictly with HIPAA security rules for remote data access.

2. Internet Connectivity Requirements

Reliable network speed is essential for real-time remote desktop connections and EHR database interactions. Applicants are required to test their connections via SpeedOf.Me to confirm compliance with the following benchmarks:

Network Metric	Requirement Benchmark	Optimal Benchmark
Download Speed	Minimum Required	10 – 20 Mbps
Upload Speed	Minimum Required	Over 5 Mbps
Latency (Ping)	Must be under 100 ms	Under 50 ms (Ideal)

Note: Network latency exceeding 100 ms is unviable for the cloud systems used by PedsOne.

Comprehensive Compensation & Employee Benefits

PedsOne provides a robust total rewards package designed to support employee health, work-life balance, and long-term financial security:

• Healthcare Coverage: Comprehensive health, vision, and dental insurance plans, alongside short-term disability coverage.

• Cumulative Time Off (CTO): Accrues starting on the very first day of employment, beginning with a baseline of 2 weeks annually.

• Paid Holidays & Time Off: Includes 6 paid holidays, 5 additional paid days, and 3 paid days for personal emergencies.

• Community Engagement: Paid time off specifically allocated for volunteer community service.

• Parental Support: Dedicated paid parental leave options for eligible growing families.

• Retirement Planning: Employee retirement plan featuring an employer match of up to 3%.

• Support Services: Access to a confidential Employee Assistance Program (EAP) for mental health and personal support resources.

• E-Verify Employer: PedsOne strictly participates in the federal E-Verify program to confirm employment eligibility.

Step-by-Step Application Instructions

To submit your application directly to PedsOne through the primary job portal, use the official link below:

Apply for the Remote Medical Billing Specialist Position at PedsOne

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