The Role
Processes, audits, submits, and rebills insurance claims while resolving denials, errors, and billing discrepancies. Ensures compliance with payer requirements, coding standards, and reimbursement regulations. Reviews patient and insurance information, monitors electronic claim transmissions, and communicates with payers and internal departments. The role also supports denial management, appeals, billing documentation, and process improvement while mentoring junior billing staff.
Summary Generated by Built In
Job Summary
The Billing Specialist II is responsible for processing and auditing insurance claims, rebilling denied claims, and resolving billing discrepancies within the electronic claims management system. This role ensures accurate and timely claim submission, identifies and corrects billing errors, and maintains compliance with payer regulations and corporate policies. The Billing Specialist II demonstrates advanced knowledge of billing procedures, coding standards, and third-party payer requirements, serving as a mentor and resource for junior billing staff.
Essential Functions
The Billing Specialist II is responsible for processing and auditing insurance claims, rebilling denied claims, and resolving billing discrepancies within the electronic claims management system. This role ensures accurate and timely claim submission, identifies and corrects billing errors, and maintains compliance with payer regulations and corporate policies. The Billing Specialist II demonstrates advanced knowledge of billing procedures, coding standards, and third-party payer requirements, serving as a mentor and resource for junior billing staff.
Essential Functions
- Processes and submits insurance claims via electronic and paper billing systems, ensuring accuracy, completeness, and compliance with payer-specific requirements.
- Reviews system account displays to verify patient demographics, balances, and insurance information prior to claim generation, making necessary corrections.
- Identifies and resolves claim errors, denials, and rejections, taking corrective action and rebilling claims within the required timeframe.
- Monitors electronic billing processes, ensuring successful claim downloads, accurate transmission, and timely follow-up on failed claims.
- Audits and assembles billing documentation, reviewing claims for completeness and applying modifications when needed to ensure proper reimbursement.
- Demonstrates proficiency in revenue codes, HCPCS, CPT coding, and payer billing guidelines, ensuring accurate claims processing and compliance with regulations.
- Responds to billing inquiries from internal departments and payers, providing resolution within two business days or escalating issues as needed.
- Maintains knowledge of third-party billing regulations, payer requirements, and automated resources to improve billing efficiency and compliance.
- Assists in mentoring and training junior billing staff, sharing expertise in claim resolution, billing requirements, and payer policies.
- Communicates with other departments, including patient access, revenue cycle, and coding teams, to ensure accurate billing information and prevent claim errors.
- Performs other duties as assigned.
- Maintains regular and reliable attendance.
- Complies with all policies and standards.
- H.S. Diploma or GED required
- Associate Degree in Business, Healthcare Administration, Medical Billing, or a related field preferred
- 2-4 years of experience in medical billing, insurance claims processing, or revenue cycle operations required
- Experience with hospital or physician billing, including payer policies, reimbursement processes, and electronic billing systems preferred
- Advanced understanding of insurance claim processing, billing regulations, and reimbursement methodologies.
- Proficiency in electronic claims management systems, revenue codes, and medical coding standards (HCPCS, CPT, UB-04, CMS-1500).
- Strong problem-solving skills with the ability to analyze claim errors, identify trends, and implement corrective actions.
- Experience with payer-specific guidelines, denial management, and appeals processes.
- Ability to work independently and as a mentor to junior billing staff, demonstrating leadership and teamwork skills.
- Proficiency in Microsoft Office Suite (Excel, Outlook, Word) and electronic health record (EHR) systems.
- Strong written and verbal communication skills for interacting with payers, internal departments, and external partners.
- CPB- Certified Medical Biller preferred
Skills Required
- High school diploma or GED
- Associate degree in Business, Healthcare Administration, Medical Billing, or a related field
- 2-4 years of experience in medical billing, insurance claims processing, or revenue cycle operations
- Experience with hospital or physician billing, payer policies, reimbursement processes, and electronic billing systems
- Certified Professional Biller (CPB) certification
Community Health Systems Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Community Health Systems and has not been reviewed or approved by Community Health Systems.
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Healthcare Strength — Stated offerings include medical, dental, vision, and prescription coverage, alongside life and disability insurance. Coverage breadth is presented as a core part of the package across affiliated hospitals.
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Leave & Time Off Breadth — Paid time off for vacation, holidays, and illness is part of the package. Time-away benefits are included as a standard element across roles and facilities, subject to local terms.
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Wellbeing & Lifestyle Benefits — Tuition assistance, student-loan support, and license or certification reimbursement are emphasized, particularly for clinical roles. These programs can reduce education costs and support ongoing professional development.
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The Company
What We Do
Community Health Systems, Inc. is one of the nation’s leading operators of general acute care hospitals. The organization’s affiliates own, operate or lease more than 80 hospitals in 16 states with approximately 15,000 licensed beds. Affiliated hospitals are dedicated to providing quality healthcare for local residents and contribute to the economic development of their communities. Based on the unique needs of each community served, these hospitals offer a wide range of diagnostic, medical and surgical services in inpatient and outpatient settings.
