Billing Specialist (Job ID OOJ - 7727)

Job Title: Billing Specialist  

POSITION SUMMARY
The Billing Specialist is responsible for the accurate and timely submission of claims to government and commercial payers across all service lines of the hospital complex, including facility (UB-04) and professional/clinic (CMS-1500) billing. This role ensures compliance with payer-specific requirements and CAH billing guidelines to maximize reimbursement and minimize denials.

ESSENTIAL FUNCTIONS
1.       Prepare and submit clean UB-04 and CMS-1500 claims to Medicare, Medicaid, commercial, and other payers across all service lines in a timely manner.
2.       Verify insurance eligibility and benefit information as part of the pre-billing process.
3.       Review claims for accuracy of codes, modifiers, revenue codes, patient demographics, and payer-specific edits within TruBridge.
4.       Monitor TruBridge claim edit and hold queues and resolve errors prior to submission.
5.       Conduct follow-up on unpaid, rejected, or pending claims and initiate appropriate corrective action.
6.       Maintain current knowledge of CAH billing requirements, swing bed billing, Medicare cost-based reimbursement, and payer-specific guidelines.
7.       Document all billing activity and account notes accurately and timely in TruBridge.
8.       Assist with month-end reporting and reconciliation as directed by the Business Office Manager. 

MINIMUM QUALIFICATIONS
Education:
High school diploma or equivalent required
 Associate's degree in a related field preferred
Experience:
Minimum 1-2 years of medical billing experience
Hospital or Critical Access Hospital billing experience preferred
Experience with multi-service line facility billing including SNF, swing bed, and outpatient services
Preferred: CPB (Certified Professional Biller) or CPC