The Role
Manage complex medical billing and claims processing, resolve denials and payment discrepancies, interact with payers and patients, maintain compliance with payer and HIPAA rules, support audits and staff training, and optimize revenue collection.
Summary Generated by Built In
Job Summary
The Billing Specialist II is responsible for managing complex billing functions, ensuring timely and accurate claims processing, and resolving issues related to insurance payments and account balances. This position serves as the primary contact for insurance companies and other payers, performing in-depth research to facilitate claim resolution and maximize collections. The Billing Specialist II also supports team training, assists with audits, and ensures compliance with payer regulations and company policies.
Essential Functions
The Billing Specialist II is responsible for managing complex billing functions, ensuring timely and accurate claims processing, and resolving issues related to insurance payments and account balances. This position serves as the primary contact for insurance companies and other payers, performing in-depth research to facilitate claim resolution and maximize collections. The Billing Specialist II also supports team training, assists with audits, and ensures compliance with payer regulations and company policies.
Essential Functions
- Serves as the primary point of contact for insurance companies, payers, and patients regarding billing inquiries and claim resolution.
- Reviews and processes insurance claims, ensuring timely submission and compliance with payer guidelines.
- Identifies and resolves credit balances, reclassifies revenue, and processes adjustments according to transaction coding policies.
- Reviews and corrects claim filing edits in electronic health record (EHR) and practice management systems (e.g., Athena, Cerner, Ingenious Med).
- Researches and resolves claim denials and rejections, working proactively to identify trends and implement corrective actions.
- Monitors and works vendor/payer audit trails, submitting secondary claims and addressing discrepancies as needed.
- Maintains up-to-date knowledge of federal, state, and payer billing guidelines, utilizing payer websites for claims follow-up.
- Assists in training staff and providers on billing updates, maintaining a centralized electronic repository for reference materials.
- Ensures proper billing and collection procedures in collaboration with management, clinic staff, and coding teams.
- Maintains confidentiality and ensures compliance with HIPAA regulations and company policies.
- Performs other duties as assigned.
- Maintains regular and reliable attendance.
- Complies with all policies and standards.
- 2-4 years of experience in medical billing, insurance claims processing, or revenue cycle management required
- 1-3 years in collections, knowledge of third party billing, and insurance reimbursement required
- 0-1 years of experience with Medicare preferred
- Advanced knowledge of medical billing processes, insurance claim procedures, and payer policies.
- Strong understanding of revenue cycle management, including insurance reimbursement and claim adjudication.
- Proficiency in electronic health records (EHR) and practice management systems.
- Ability to analyze and resolve complex billing issues, including denials and payment discrepancies.
- Strong communication and problem-solving skills to interact with patients, providers, and payers.
- Ability to train and mentor team members on billing best practices.
- Detail-oriented with the ability to meet deadlines and manage multiple priorities.
- Working knowledge of HIPAA regulations and data confidentiality requirements.
- CPB- Certified Medical Biller issued by AAPC preferred or
- Certified Medical Insurance Specialist (CMIS) issued by PMI preferred
Skills Required
- 2-4 years of experience in medical billing, insurance claims processing, or revenue cycle management
- 1-3 years experience in collections, knowledge of third-party billing, and insurance reimbursement
- Proficiency with electronic health records (EHR) and practice management systems (e.g., Athena, Cerner, Ingenious Med)
- Ability to research and resolve claim denials, rejections, and payment discrepancies
- Working knowledge of HIPAA regulations and data confidentiality requirements
- 0-1 years of experience with Medicare
- CPB (AAPC) or CMIS (PMI) certification
Am I A Good Fit?
Get Personalized Job Insights.
Our AI-powered fit analysis compares your resume with a job listing so you know if your skills & experience align.
Success! Refresh the page to see how your skills align with this role.
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.
