Medical Hospital Billing Specialist

Medical Hospital Billing Specialist

The Medical Hospital Billing Specialist is responsible for accurate and timely billing of hospital services to insurance payers and patients. This role plays a critical part in the revenue cycle by ensuring claims are submitted correctly, payments are posted appropriately, and accounts are resolved efficiently while maintaining compliance with payer and regulatory requirements.

Prepare, review, and submit hospital claims (inpatient, outpatient, and/or ancillary services) to commercial, Medicare, and Medicaid payers

Verify patient insurance coverage, authorizations, and benefits as needed

Ensure accurate charge capture, coding validation, and modifier usage prior to claim submission

Monitor claim status and follow up on unpaid, denied, or underpaid claims

Research and resolve claim denials, payment variances, and payer rejections

Post payments, adjustments, and contractual allowances accurately

Maintain detailed account notes and documentation in the billing system

Communicate effectively with payers, patients, and internal departments to resolve billing issues

Stay current on payer guidelines, billing regulations, and compliance requirements

Meet productivity and accuracy standards established by the department

High school diploma or equivalent required; associate's degree preferred

Minimum of [13] years of hospital billing experience required

Strong knowledge of hospital billing processes, UB-04 claims, and payer guidelines

Familiarity with CPT, HCPCS, ICD-10 coding concepts

Experience with Medicare, Medicaid, and commercial insurance payers

Proficiency with electronic health records (EHR) and billing systems

Strong attention to detail and analytical skills

Ability to manage multiple priorities and work independently

Excellent written and verbal communication skills

Experience in inpatient and outpatient hospital billing

Knowledge of denial management and appeals

Familiarity with revenue cycle metrics and AR follow-up workflows

Certification such as CPB, CPC, or equivalent (preferred but not required)

Collaborative, fast-paced healthcare environment

Competitive compensation based on experience

Comprehensive benefits package including medical, dental, vision, PTO, and retirement options

Opportunities for professional growth and continuing education