Hospital Revenue Cycle Specialist - Billing

Description

The Hospital Revenue Cycle Specialist – Billing is responsible for coordinating and performing billing, payment posting, and collections activities to ensure accurate and timely reimbursement. This role manages assigned payer accounts, resolves billing issues, monitors reimbursement accuracy, and supports efforts to reduce accounts receivable. The Specialist provides operational support and backup to the Revenue Cycle Director while ensuring compliance with applicable billing regulations, payer requirements, and hospital policies.

• Prepares, reviews, and submits electronic and hard copy claims for all payers.
• Reviews and corrects billing errors, late charges, and process rejections.
• Compiles and submits files for patient statements, bad debt, and third-party vendors.
• Reviews credit balances, verifies refunds, and processes refund requests for leadership approval.
• Monitors payer remittances, researches variances, and initiates appeals as needed.
• Works assigned accounts to reduce accounts receivable by addressing denials, underpayments, over payments, and unpaid claims.
• Collaborates with the Revenue Cycle Director, payers, and internal departments to resolve billing issues.
• Reviews accounts for collection activity, including correspondence, phone follow-up, and agency placement.
• Sorts, responds to, documents, and files correspondence while maintaining accurate account records.
• Provides backup support for other revenue cycle functions as needed.
• Ensure compliance with HIPAA and all federal and state privacy protection laws and regulations.
• Performs special projects and other duties as assigned.

• Demonstrates a working knowledge of the end-to-end revenue cycle, including billing, follow-up, collections, reimbursement, and payer requirements.
• Maintains compliance with federal and state regulations, payer guidelines, hospital policies, and HIPAA privacy requirements.
• Ensures accuracy and attention to detail in all financial transactions, documentation, and correspondence.
• Apply problem-solving and critical-thinking skills to identify discrepancies and resolve account or billing issues.
• Communicate professionally and effectively with patients, payers, physicians, and internal departments.
• Effectively manages time and workload to meet productivity and departmental goals.
• Works collaboratively with team members and leadership, providing backup support as needed.
• Demonstrate proficiency with billing systems, electronic health records, and standard office software; adapts to system changes as required.
• Participates in ongoing education and identifies opportunities to improve processes, efficiency, and financial performance.
• Upholds professionalism, accountability, confidentiality, and SHOLA’s commitment to exceptional patient satisfaction.

Disclaimer:
The statements above are intended to describe the general nature and level of work performed by individuals assigned to this position. They are not intended to be an exhaustive list of all responsibilities, duties, or skills required. Additional duties may be assigned as needed to support the organization’s ongoing operations and mission.

• A high school diploma or equivalent is required, and a college degree in a business-related field is preferred.

• Minimum three (3) years of experience in a medical business office performing billing, payment posting, follow-up, and collections preferred.

• Knowledge of the full revenue cycle, government and commercial payers, CPT/HCPCS, and ICD-10 coding, billing laws, and reimbursement practices.
• Strong interpersonal, organizational, and communication skills.
• Proficiency in Excel, Word, and billing software such as Meditech, SSI, or Passport preferred.