Hospital Billing Specialist

Under general supervision, the Hospital Billing and Follow-Up Specialist handles essential billing and insurance follow-up functions. This role requires a fundamental understanding of insurance claim processing, knowledge of UB and HCFA claim forms, and the ability to interpret insurance explanation of benefits (EOBs), handle denials, and perform follow-up with insurers to ensure claims resolution.

The position includes business office responsibilities related to patient accounts, such as charge import, diagnostic and procedural coding, and claim follow-up with third-party payers to achieve zero-balance resolution.

This position may have the possibility of becoming remote after 6 months, at management’s discretion.

Responsibilities

• Import charges from queues in a timely manner and append modifiers or other required information for claim transmission
• Review daily accounts ready to be billed in Waystar from Meditech
• Initiate correction on all claims with errors by the designated time
• Follow up on correspondence received that day or the previous day
• Cross-train on billing all lines of business to different payers
• Pull listings of accounts assigned for follow-up by specific payer
• Perform diagnostic and procedural coding
• Resubmit primary, secondary, and tertiary claims per applicable regulations and policies
• Communicate with third-party representatives to complete claims processing and resolve problem claims
• Follow up daily on post-processing activity, including rejected billings, adjustments, rebilling, and denied claims
• Maintain accounts receivable detail through tasking
• Maintain standards per payer for accounts over 90 days
• Meet minimum account work standards per payer per day
• Meet or exceed collection goals by payer each month
• Work assigned accounts based on balance
• Participate in educational activities and monthly department staff meetings
• Maintain confidentiality and comply with HIPAA guidelines and regulations
• Perform other duties as assigned