Medical Hospital Billing Specialist

Location: On-site / Hybrid / Remote
Department: Revenue Cycle / Patient Financial Services
Employment Type: Full-Time 

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 [1–3] 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
  
  **Applicants must be legally authorized to work in the United States. We are unable to sponsor or take over sponsorship of an employment visa at this time.