Job Description

Position Summary:

The Revenue Cycle Specialist – Hospital Billing is responsible for supporting the financial operations of the hospital by reviewing accounts, preparing and submitting claims (both paper and electronic), processing payments, resolving denials, and maintaining accurate patient accounting records. This role requires consistent communication with insurance companies, patients, and internal departments to ensure timely and accurate billing and collections.

Key Responsibilities:

• Prepare, review, and submit accurate insurance claims (electronic and paper) in a timely manner.
• Correct claim edits and ensure compliance with payer guidelines.
• Process insurance denials, rejections, and correspondence.
• Post various types of payments (e.g., insurance, patient, adjustments).
• Document all billing and communication activity in the patient accounting system.
• Follow up on outstanding accounts by generating Patient Balance Aging and Insurance Aging reports.
• Contact insurance companies for authorizations and pre-certifications, and document appropriately.
• Audit patient accounts for completeness and accuracy; apply necessary adjustments.
• Provide billing-related customer service and set up payment plans when appropriate.
• Escalate unresolved issues to the Supervisor promptly.
• Attend required training sessions and maintain up-to-date knowledge of billing processes.
• Perform additional tasks as directed by management.

Qualifications:

Education:

• Option 1: Bachelor’s Degree from an accredited college or university; OR
• Option 2: High School Diploma or equivalent recognized by the State Department of Education AND four (4) years of full-time experience in billing, collections, interviewing, investigation, or a related field (e.g., credit or bookkeeping);
• Note: College education may substitute for experience (30 semester credits = 1 year of experience). However, a high school diploma or equivalent is required for all candidates.

Required Skills:

• Strong knowledge of medical billing practices and the healthcare revenue cycle
• Experience with patient financial systems and claim processing software
• Proficient in Microsoft Office (especially Excel)
• Strong written and verbal communication skills
• Detail-oriented and able to prioritize tasks efficiently
• Ability to work independently and within a team

Pride Health offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.

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