Medical Billing Specialist

Job Summary:

The Billing Specialist is responsible for the accurate and timely submission of claims to government and commercial payers across all service lines of the hospital complex, including facility (UB-04) and professional/clinic (CMS-1500) billing. This role ensures compliance with payer-specific requirements and CAH billing guidelines to maximize reimbursement and minimize denials.

Essential Functions:

1. Prepare and submit clean UB-04 and CMS-1500 claims to Medicare, Medicaid, commercial, and other payers across all service lines in a timely manner.

2. Verify insurance eligibility and benefit information as part of the pre-billing process.

3. Review claims for accuracy of codes, modifiers, revenue codes, patient demographics, and payer-specific edits within TruBridge.

4. Monitor TruBridge claim edit and hold queues and resolve errors prior to submission.

5. Conduct follow-up on unpaid, rejected, or pending claims and initiate appropriate corrective action.

6. Maintain current knowledge of CAH billing requirements, swing bed billing, Medicare cost-based reimbursement, and payer-specific guidelines.

7. Document all billing activity and account notes accurately and timely in TruBridge.

8. Assist with month-end reporting and reconciliation as directed by the Business Office Manager.

Non-Essential Functions:

• Perform other duties as assigned by the Director, CBO or HIM Manager.
• Assist with cross-training and support of other CBO staff as needed.

Requirements:

• High school diploma or equivalent required.
• Associate's degree in a related field preferred.
• Minimum 1-2 years of medical billing experience.
• Hospital or Critical Access Hospital billing experience preferred.

Knowledge, Skills, and Abilities:

• Knowledge of CPT, ICD-10, HCPCS coding, and revenue codes.
• Familiarity with UB-04 and CMS-1500 claim formats and Medicare/Medicaid billing requirements.
• Experience with TruBridge or comparable community hospital EHR/PM system preferred.
• Strong attention to detail, organizational skills, and ability to meet deadlines.
• Proficiency in Microsoft Office Suite.
• Experience with multi-service line facility billing including SNF, swing bed, and outpatient services.
• Preferred: CPB (Certified Professional Biller) or CPC.

Pay: $24.00 per hour

Experience:

• Medical billing: 2 years (Required)
• CPT coding: 1 year (Required)
• ICD coding: 1 year (Required)
• TruBridge: 1 year (Required)
• Insurance verification: 1 year (Required)

License/Certification:

• Certified Professional Coder (Required)

Ability to Commute:

• Hopedale, IL 61747 (Required)

Work Location: In person

Salary : $24