(Remote) Hospital Billing Representative

About the role

MEDHOST, a division of Harris, is seeking a Hospital Billing Representative who will support front end hospital billing and clean claim submission for insurance payers, including Medicare, Medicaid, Blue Cross, commercial payers, and other government entities. This position is focused on front end hospital billing.

Responsibilities

• Review, correct, and submit hospital claims through billing clearinghouses and payer systems.
• Review and resolve front end claim edits before claims are released to payers.
• Correct billing issues related to diagnosis codes, procedure codes, charge codes, payer requirements, demographics, authorization details, or claim formatting.
• Work claim edit queues, rejected claim files, DDE claims, late charge claims, rebills, corrected claims, and shadow claims as assigned.
• Maintain a high clean claim rate by ensuring claims meet payer billing guidelines before submission.
• Use hospital billing software and third party clearinghouses to process and monitor claims at the submission stage.
• Maintain working knowledge of all software applications related to hospital billing and claims submission.
• Ensure facility rebills are worked and comments are logged on patient accounts within 7 business days.
• Communicate issues impairing the billing process to the Team Lead or Manager.
• Communicate with hospitals, internal teams, and payers when additional information is needed to correct and submit claims.
• Partner with other teams and departments to resolve billing, payer, clearinghouse, or claim submission issues.
• Submit billing and rebilling requests from customers and team members in a timely manner.
• Stay current with billing practices for private and government payers, including billing software applications and clearinghouse requirements.
• Assist in the training and education of new and existing employees.
• Maintain the effectiveness and implementation of the MEDHOST Quality Management System and meet applicable regulatory requirements.
• Accurately input and submit worked time by departmental deadlines.
• Maintain in depth knowledge of MEDHOST core products and third party clearinghouses.
• Maintain industry knowledge through self study and training.
• Recommend department and customer documentation.
• Provide training and training documentation in areas of expertise.
• Attend and participate in team and departmental meetings.
• Respond to emails, telephone calls, voicemails, Microsoft Teams messages, and correspondence from facilities in a timely manner.
• Adhere to all HIPAA Privacy and Security requirements.
• Perform duties in a positive manner that upholds company policies and procedures.
• Perform other duties as assigned.

Requirements

• High School diploma or equivalent required.
• Minimum 1 year of front end hospital billing experience required.
• Minimum 1 year of experience submitting hospital claims through billing clearinghouses required.
• Minimum 1 year of experience utilizing hospital claims management or billing software required.
• Experience resolving front end claim edits before payer adjudication required.
• Experience working with hospital billing systems, claim edit queues, clearinghouse platforms, and payer submission workflows required.
• Working knowledge of institutional hospital claims, payer billing requirements, clean claim submission, rebills, corrected claims, late charges, DDE claims, and claim edit resolution.
• Ability to clearly explain prior experience with clearinghouses such as SSI, Availity, Waystar, Change Healthcare, TrueBridge, or Quadax.
• Ability to identify claim errors before submission and take appropriate corrective action.
• Ability to follow billing standards, department procedures, and payer guidelines independently.
• Strong attention to detail and ability to manage billing inventory accurately.
• Computer skills in Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook.
• Customer service orientation with the ability to support internal teams, facilities, and customers professionally.
• High speed internet access with minimum 300 Mbps download speed and unlimited data.
• Smart phone for Multi Factor Authentication application.

Skills

• MEDHOST or HMS knowledge.
• Experience maintaining a strong clean claim rate.
• Experience submitting Medicare, Medicaid, Blue Cross, commercial, and government payer claims.
• Experience working claim edit queues within a hospital billing environment.
• Experience with UB04, 837I, DDE, rebills, corrected claims, late charges, and clearinghouse edits.
• Knowledge of hospital billing, revenue cycle, and medical terminology.
• Ability to navigate healthcare information systems and clearinghouses.
• Ability to access protected health information in accordance with departmental assignments and guidelines.
• Skilled in making accurate arithmetic computations.
• Excellent verbal and written communication skills, good judgment, tact, initiative, and resourcefulness.
• Detail oriented, organized, and able to manage multiple priorities.
• Ability to demonstrate supportive relationships with peers, clients, partners, and corporate executives.
• Flexible with a can do attitude and ability to remain professional under high pressure situations.

Benefits

• 3 weeks’ vacation and 5 personal days
• Comprehensive Medical, Dental, and Vision benefits starting from your first day of employment
• Employee stock ownership and RRSP/401k matching programs
• Lifestyle rewards
• Remote work and more!

Pay

Wage $18-$28/hr