Business Office Biller

Position Summary

The Hospital Biller is responsible for accurate and timely billing of inpatient, outpatient, clinic, and ancillary services in accordance with Medicare, Medicaid, and commercial payer requirements. This role is critical in supporting the financial health of the Critical Access Hospital while ensuring compliance with federal and state regulations.

Essential Duties and Responsibilities

• Prepare, review, and submit claims for inpatient, outpatient, clinic, emergency, and ancillary services

• Ensure compliance with CAH billing regulations, including cost-based reimbursement guidelines

• Verify patient insurance coverage and benefits prior to billing

• Correct billing errors, edit claims, and resolve rejections or denials

• Post payments, adjustments, and contractual allowances accurately

• Follow up on unpaid claims and communicate with payers as needed

• Maintain accurate billing records and documentation for audits and surveys

• Collaborate with coding, registration, and clinical departments to resolve discrepancies

• Respond to patient billing inquiries professionally and confidentially

• Assist with month-end close, reports, and reimbursement tracking

• Support internal and external audits, including Medicare and Medicaid reviews

Knowledge, Skills, and Abilities

• Knowledge of hospital billing processes, including Medicare, Medicaid, and commercial payers

• Familiarity with CAH-specific billing and reimbursement rules

• Strong attention to detail and accuracy

• Ability to manage multiple priorities in a fast-paced environment

• Effective communication and customer service skills

• Proficiency with hospital billing systems and electronic health records

Education and Experience

• High school diploma or equivalent required

• Associate degree in healthcare administration, business, or related field preferred

• Minimum of 1–3 years of hospital billing experience, preferably in a CAH setting

• Experience with Medicare cost-based billing strongly preferred

Certifications (Preferred)

• Certified Professional Biller (CPB) or equivalent

• Experience with Medicare Rural Hospital or CAH billing regulations

Physical and Work Requirements

• Ability to sit for extended periods

• Frequent use of computer and office equipment

• Occasional lifting of office materials up to 25 pounds

Compliance Statement

All employees are expected to adhere to hospital policies, HIPAA regulations, and federal and state compliance standards.