Hospital Medical Billing Specialist

Essential Job Functions

• Prepares and submits accurate hospital claims to Medicare, Medicaid, and commercial payers.
• Reviews patient accounts for completeness and accuracy prior to billing.
• Ensures compliance with federal, state, and payer-specific billing regulations.
• Posts payments and adjustments accurately to patient accounts.
• Works claim edits and resolves billing rejections and denials in a timely manner.
• Communicates with insurance companies regarding claim status, corrections, and appeals.
• Assists patients with billing inquiries and provides excellent customer service.
• Maintains confidentiality in accordance with HIPAA guidelines.
• Collaborates with clinical and registration departments to ensure proper charge capture.
• Assists with month-end reporting and revenue reconciliation as needed.
• Posting charges daily for multiple departments.
• Daily reviewing of a statement report in the RCM software and either approving the statement, applying an adjustment, or sending it through the RCM system to be reworked.
• Performing billing functions at minimum three days a month while the Lead Billing Coordinator is Billing Long Term Care and when the Lead Billing Coordinator is out.
• Performing cash management duties at least once monthly and covering that position when the Cash Manager is out.
• Performing the balancing of Long Term Care accounts.
• On a quarterly basis, work with the HIM staff to correct and submit the ACHA report for inpatient and outpatient.
• Completes assigned duties within required time frame, according to established schedules or workflow requirements.
• Serves as a resource to co-workers.
• Supports and promotes the Mission, Vision, and Values; adheres to hospital policies and procedures; maintains professional appearance.
• Other duties as assigned.

• High school diploma or GED required;
  Associate degree in Business, Healthcare Administration, or related field preferred.
• Minimum of 2 years of medical billing experience and cash management, preferably in a hospital setting.
• Knowledge of hospital billing procedures, insurance claims processing, and reimbursement guidelines.
• Experience with Medicare, Medicaid, commercial insurance, and managed care billing.
• Proficiency in electronic health records (EHR) and billing software systems.
• Strong understanding of revenue cycle processes.
• Excellent attention to detail and accuracy.
• Strong organizational and time management skills.
• Effective written and verbal communication skills.

Office setting within a hospital environment.

Day shifts, Monday - Friday.

Minimum of 2 years of medical billing experience, preferably in a hospital setting.

Billing or coding certification preferred.

• Prolonged periods of sitting and working at a computer.
• Frequent use of standard office equipment (computer, phone, copier, scanner).
• Occasional standing, walking, bending, and reaching.
• May require interaction with patients, staff, and insurance representatives in person or by phone.
• Must be able to lift up to 10-15 pounds (files, office supplies).

Work Remotely: No

This description reflects the essential functions of the role and does not include every task that may be assigned. Responsibilities, knowledge, skills, abilities, schedule, and working conditions may change as needed.

Northwest Florida Community Hospital is an equal opportunity employer. All employment decisions are based on business needs, job requirements, and individual qualifications, without discrimination on protected characteristics. Applicants may be required to undergo pre-employment screening where permitted by law.