About this role
Role Overview
- Prepare, review, and submit hospital and RHC claims to commercial insurance carriers.
- Ensure correct use of CPT, HCPCS, ICD-10, revenue codes, modifiers, and RHC-specific billing requirements.
- Verify charges, units, dates of service, provider credentials, and place of service.
- Analyze and resolve billing denials, rejections, and underpayments.
- Identify root causes of denials (coding, authorization, eligibility, medical necessity, bundling, timely filing, etc.).
- Conduct timely follow-up with payers on unpaid, underpaid, or delayed claims.
- Communicate with insurance representatives to obtain claim status and resolution.
- Ensure compliance with payer guidelines, hospital policies, and RHC billing regulations.
- Work closely with coding, registration, authorization, and clinical staff to resolve billing issues.
Requirements
- Knowledge of full-cycle RCM billing processes for acute-hospital and/or rural health clinics REQUIRED.
- Experience working with HB & PB Epic, with strong experience working with PB Epic REQUIRED.
- Strong experience with insurance billing and denial resolution.
- Proficiency in CPT, ICD-10-CM, HCPCS, and modifiers.
- Familiarity with payer portals and claim management systems.
- Strong analytical, organizational, and follow-up skills.
- Ability to manage high-volume workloads with attention to detail.
Benefits
- Health insurance
- Opportunities for professional development