Inpatient Medical Biller

About the role

Nexus Health Systems is seeking an experienced Inpatient Medical Biller to join their Central Business Office. This role is responsible for the accurate and timely billing of inpatient hospital claims to government and commercial payers.

Responsibilities

• Prepare, review, and submit accurate inpatient hospital claims for Medicare, Medicaid, managed care, and commercial insurance payers.
• Submit claims electronically through a clearinghouse and monitor claim acceptance, edits, and rejections.
• Review patient accounts and billing documentation to ensure claims are complete, accurate, and compliant prior to submission.
• Verify all required documentation is present to support timely reimbursement.
• Research and resolve claim edits and rejections to ensure clean claim submission.
• Correct and resubmit claims as needed.
• Maintain accurate documentation within patient accounts and billing systems.
• Coordinate with facility staff and internal departments to obtain supporting documentation for claim submission.
• Identify billing trends or process issues that could impact reimbursement and recommend improvements.
• Maintain compliance with all federal, state, and payer billing regulations.
• Assist with additional revenue cycle responsibilities as assigned.

Qualifications

• High school diploma or equivalent.
• Minimum of one (1) year of inpatient hospital medical billing experience.
• Experience submitting claims through an electronic clearinghouse.
• Strong understanding of medical billing codes, payer requirements, and claim submission guidelines.
• Experience billing Medicare, Medicaid, managed care, commercial insurance, and out-of-state payers.
• Exceptional attention to detail and organizational skills.
• Strong communication and problem-solving abilities.
• Proficiency with electronic medical records and billing software.
• Prioritize associate degree or college coursework in Healthcare Administration, Business, or a related field.
• Experience with UB-04 claims, electronic remittance advice (ERA), and EDI transactions.
• Experience billing for inpatient rehabilitation, behavioral health, long-term acute care, or specialty hospitals.
• Knowledge of denial prevention and clean claim best practices.