Specialist, Billing

Billing (Hospital & Rural Focus)

Evaluate, coordinate, develop, and implement billing processes, with a strong focus on critical access hospital, RHC, and facility-based billing workflows.
Process electronic and paper claims accurately and timely, ensuring compliance with CAH reimbursement methodologies and payer-specific billing requirements.
Resolve clearinghouse and DDE claim errors and payer rejections, including those specific to hospital and rural facility billing.
Follow up on underpaid or unpaid claims, particularly those involving complex hospital billing structures, cost-based reimbursement, and rural payer nuances.
Research and resolve issues impacting reimbursement, including medical necessity, coding discrepancies, and facility-specific billing requirements.
Review balances post-insurance to ensure proper adjudication based on hospital and CAH billing guidelines.
Resolve overpayments, including reconciliation of facility claims and cost-based reimbursements.
Process payer correspondence and take appropriate action using internal and external resources.
Maintain aging reports and proactively address accounts nearing timely filing limits.
Resolve denied claims using payer reconsideration and appeals processes, with emphasis on facility and rural claim denials.
Document all account activity thoroughly within the EHR system.

Credentialing

Perform credentialing and re-credentialing for facilities and providers, ensuring alignment with hospital and rural billing requirements.
Maintain accurate provider and facility data for payer enrollment and reimbursement.
Ensure CAQH profiles are complete and current.
Mentorship:

• Serve as a subject matter expert in critical access, RHC, and hospital billing.
  Assist staff in troubleshooting complex billing issues, especially those related to facility claims and rural reimbursement models.
  Mentor team members to improve efficiency and accuracy in billing processes.
  Develop workflows and documentation specific to hospital and rural billing best practices.

Reporting

Review and act on accounts receivable reports (DNFB, ATB, denials, clean claims, etc.), with attention to hospital billing performance metrics.
Prepare reports to address payer discrepancies, particularly those involving facility reimbursement issues.

Qualifications

• High School Diploma required; Associate’s or Bachelor’s degree preferred.
  Minimum of 2 years of medical billing experience required (5+ years preferred), with a strong emphasis on:
  Critical Access Hospital (CAH) billing – strongly preferred
  Hospital/facility billing – required
  Rural Health Clinic (RHC) billing – preferred
  Proven experience working with facility-based claims, UB-04 billing, and payer reimbursement methodologies
  Strong knowledge of medical and insurance terminology
  Proficiency with Microsoft Office
  Knowledge of Nebraska payer rules is a plus

Working Conditions

• Work from home with a stable internet connection, a dedicated workspace, and access to necessary equipment.
  Requires prolonged sitting and consistent communication via phone, email, and video conferencing.
  Remote work is expected 100% of the time unless otherwise agreed upon.
  This role requires access to confidential information and adherence to all privacy and security policies.