Hospital Billing Specialist Job Description

Job Title: Hospital Billing Specialist
Department: Billing and Finance
Reports To: Billing Manager/Revenue Cycle Manager
FLSA Status: Non-Exempt

Position Summary: The Hospital Billing Specialist is responsible for managing patient billing processes, ensuring accuracy in charges, claims, and payments, and providing customer support to resolve billing inquiries. This role involves handling insurance claims, working with various payers, and maintaining compliance with healthcare regulations. The Billing Specialist ensures that all billing activities are conducted efficiently and effectively to maximize revenue and minimize errors.

Key Responsibilities:

1. Billing and Invoicing:

   • Prepare and submit accurate claims to insurance companies, Medicare, Medicaid, and other third-party payers.
   • Generate and review patient bills for accuracy, including itemized charges for services rendered.
   • Ensure that all services are coded correctly according to current regulations and guidelines.

2. Claims Management:

   • Monitor the status of submitted claims, ensuring timely processing.
   • Follow up on unpaid or denied claims, taking necessary steps to resolve issues.
   • Correct and resubmit claims when necessary to ensure proper payment.

3. Patient Accounts:

   • Manage patient account balances, including posting payments and adjustments.
   • Respond to patient inquiries regarding their bills, insurance coverage, and payment options.
   • Set up payment plans for patients with outstanding balances.

4. Insurance Verification:

   • Verify patient insurance coverage and benefits prior to services being rendered.
   • Coordinate with insurance companies to resolve discrepancies and coverage issues.

5. Compliance and Documentation:

   • Maintain compliance with all federal, state, and local regulations, including HIPAA, Medicare, and Medicaid billing guidelines.
   • Keep accurate and detailed records of all billing activities, claims, payments, and correspondence.

6. Reporting and Analysis:

   • Prepare regular reports on billing activities, outstanding claims, and accounts receivable.
   • Analyze billing data to identify trends, discrepancies, and opportunities for improvement.

7. Collaboration:

   • Work closely with the medical coding team to ensure accurate and timely billing.
   • Collaborate with other departments, such as Patient Admissions and Finance, to streamline billing processes and resolve issues.

8. Customer Service:

   • Provide excellent customer service to patients, families, and healthcare providers regarding billing issues.
   • Handle sensitive patient information with discretion and confidentiality.

Qualifications:

• Education: High school diploma or equivalent required; Associate’s degree or certification in medical billing/coding preferred.
• Experience: Minimum of 2 years of experience in hospital billing, medical billing, or related field.
• Technical Skills: Proficient in billing software (e.g., Epic, Cerner, or similar systems), electronic health records (EHR), and Microsoft Office Suite.
• Knowledge: Strong understanding of medical billing procedures, insurance claims processing, and healthcare regulations (e.g., HIPAA, Medicare, Medicaid).
• Communication: Excellent verbal and written communication skills; ability to explain billing procedures and issues clearly.
• Attention to Detail: High level of accuracy and attention to detail in managing financial records.
• Problem-Solving: Ability to identify and resolve billing issues effectively.
• Customer Service: Strong customer service skills with the ability to handle sensitive situations professionally.

Working Conditions:

• Typically works in an office setting within the hospital.
• May require occasional overtime to meet deadlines or resolve urgent billing issues.
• May involve sitting for long periods and using a computer for extended periods.

Physical Requirements:

• Ability to perform routine office tasks such as typing, filing, and using office equipment.
• May require lifting and moving files and documents.