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