Medical Billing Specialist

Job Details:

Job Location:

Rice Community Hospital - Lyons, KS 67554, Position Type:
Full Time, MEDICAL BILLING SPECIALIST

Department:
Administration

Reports To:

Revenue Cycle Director

Supervises:
None

Status:
Full-Time

FLSA Status:
Non-Exempt

The Medical Billing Specialist is responsible for accurate and timely billing, follow-up, and resolution of patient and insurance accounts for Rice Community Health. This position supports the hospital, Rural Health Clinics (RHCs), and other applicable healthcare services and is responsible for ensuring claims are submitted accurately, appropriately adjudicated, and followed through to payment or resolution.

The Medical Billing Specialist works closely with Revenue Cycle, Health Information Management, Registration, clinical departments, and external payers to identify and resolve billing issues that may delay or prevent reimbursement. The position requires a strong understanding of medical billing practices, payer requirements, hospital and RHC billing, and applicable federal and state regulations.

The successful candidate will demonstrate attention to detail, strong organizational and problem-solving skills, and the ability to manage multiple accounts and priorities while maintaining confidentiality and compliance with applicable laws and Rice Community Health policies.

• High school diploma or equivalent required.
• Associate's degree in medical billing, healthcare administration, accounting, or a related field preferred.
• Minimum of two years of medical billing, healthcare revenue cycle, or related experience preferred.
• Experience with hospital or facility billing preferred.
• Experience with Critical Access Hospital (CAH) and/or Rural Health Clinic (RHC) billing strongly preferred.
• Experience with CPSI/Tru Bridge and eClinical
  
  Works strongly preferred, particularly experience performing hospital and/or RHC billing within these systems.
• Experience working with electronic claims, clearinghouses, payer portals, and Electronic Health Record (EHR) systems preferred.
• Experience with UB-04 and CMS-1500 claims preferred.

• Review, prepare, and submit accurate and timely hospital, RHC, and other healthcare claims to third-party payers.
• Review claims for accuracy and completeness prior to submission and identify information that may result in denials or payment delays.
• Work clearinghouse edits, DDE errors, payer rejections, and other claim issues in a timely manner.
• Monitor claims from submission through adjudication and payment.
• Follow up on unpaid, underpaid, and delayed claims in accordance with established Revenue Cycle workflows.
• Research and resolve claim discrepancies involving eligibility, authorization, coding, medical necessity, billing requirements, and payer policies.
• Review accounts after insurance processing to ensure payments, adjustments, contractual allowances, and patient responsibility are accurately posted.
• Identify and resolve payment variances and potential underpayments.
• Process payer correspondence and take appropriate action to resolve outstanding issues.
• Maintain appropriate documentation of billing activity, follow-up, and account resolution within the applicable systems.
• Monitor accounts receivable and prioritize accounts based on aging, balance, payer requirements, and timely filing deadlines.
• Submit reconsiderations, corrected claims, appeals, and other payer requests as appropriate.
• Identify recurring billing issues and communicate trends or concerns to Revenue Cycle leadership.

• Work assigned denial and accounts receivable reports to identify and resolve outstanding balances.
• Research the cause of denials and determine the appropriate corrective action.
• Submit corrected claims, reconsiderations, appeals, or supporting documentation as appropriate.
• Monitor accounts approaching timely filing or other payer deadlines.
• Identify patterns of denials or payment issues and communicate opportunities for process improvement.
• Assist with efforts to reduce accounts receivable aging and improve clean claim rates.

• Maintain accurate payer information and billing requirements within applicable systems.
• Stay current on changes to Medicare, Medicaid, commercial payer, and other applicable billing requirements.
• Maintain working knowledge of CMS regulations, payer policies, and reimbursement requirements applicable to hospital and RHC services.
• Maintain…