What are the responsibilities and job description for the Inpatient Billing Specialist position at Riverbend Rehabilitation Hospital?
The Inpatient Billing Specialist is responsible for accurate and timely billing of inpatient hospital services. This role ensures compliance with payer requirements, hospital policies, and federal and state regulations while maximizing reimbursement and minimizing denials.
Key ResponsibilitiesReview inpatient medical records to ensure complete and accurate charge capture
Prepare, review, and submit inpatient claims to Medicare, Medicaid, and commercial payers
Assign and validate appropriate diagnosis and procedure codes (ICD-10-CM/PCS, DRG/APR-DRG)
Ensure compliance with payer billing guidelines, CMS regulations, and hospital policies
Monitor claim status and follow up on unpaid, underpaid, or denied claims
Research and resolve billing discrepancies, edits, and claim rejections
Work closely with coding, utilization review, case management, and clinical staff to resolve issues
Process corrections, adjustments, and rebills as needed
Maintain detailed documentation of billing activities and payer communications
Meet productivity and accuracy standards while adhering to billing timelines
High school diploma or equivalent (Associate’s degree preferred)
2 years of inpatient hospital billing experience
Strong knowledge of inpatient billing regulations and payer requirements
Proficiency in ICD-10-CM/PCS and DRG methodologies
Experience with hospital billing systems and electronic health records (EHR)
Strong attention to detail and analytical skills
Ability to work independently and manage multiple priorities
Certification such as CPB, CPC, CCS, or RHIT/RHIA
Experience with Medicare inpatient billing and audits
Familiarity with denial management and appeals
Knowledge of UB-04 claim forms and electronic claim submission
Excellent organizational and time-management skills
Strong written and verbal communication abilities
Problem-solving and critical-thinking skills
Ability to interpret medical documentation and billing regulations
Proficiency in Microsoft Office and billing software