POSITION PURPOSE

The Claims Billing Specialist is responsible for the accurate and timely billing and follow-up of insurance claims to maximize reimbursement while ensuring compliance with all federal, state, payer, and organizational guidelines. This position performs claim submission, insurance follow-up, denial management, appeals, and reimbursement resolution. The Claims Billing Specialist works collaboratively with the Patient Financial Services Director, Billing Supervisor, coding staff, and insurance payers to ensure clean claims and efficient revenue cycle operations.

MINIMUM MANDATORY

qualifications

Experience:

Demonstrated experience with insurance billing, claim follow-up, denial management, and appeals. Working knowledge of

CPT, HCPCS, ICD-10-CM

coding, medical terminology, and payer billing requirements.

Education:

High school diploma or GED required. Associate degree in Healthcare Administration, Business, or a related field. Professional certification such as Certified Professional Biller (CPB) Experience with Critical Access Hospital reimbursement methodologies and revenue cycle operations.

Mandatory Knowledge, Skills, Abilities and Other Qualifications:

Knowledge of the back-end revenue cycle process, including government and commercial insurance processes. Thorough understanding of the medical billing and insurance collection process. Ability to research and resolve complex outstanding claims through critical thinking and problem-solving. Experience with denial management, appeals, claim corrections, and reimbursement recovery. Excellent computer skills with proficiency in electronic health record (EHR) systems, billing software, clearinghouses, Microsoft Office applications, and electronic payer portals. Ability to communicate effectively and professionally with insurance representatives to resolve claim issues and negotiate reimbursement when appropriate. Excellent verbal and written communication skills. Strong organizational, analytical, and time management skills. High attention to detail with the ability to prioritize multiple tasks and meet deadlines. Ability to work independently while contributing effectively as a member of the Patient Accounts team. Commitment to maintaining confidentiality and professionalism. Preferred qualifications Minimum of three (3) years of medical billing experience in a Critical Access Hospital (CAH) preferred.