Medical Hospital Billing Specialist

The Medical Hospital Billing Specialist is responsible for the accurate and timely billing of hospital services to insurance payers and patients, playing a vital role in the revenue cycle by ensuring claims are submitted correctly, payments are posted accurately, and accounts are resolved efficiently while maintaining full compliance with payer and regulatory requirements. This position involves preparing, reviewing, and submitting hospital claims for inpatient, outpatient, and ancillary services to commercial, Medicare, and Medicaid payers, as well as verifying patient insurance coverage, authorizations, and benefits when needed. The specialist ensures accurate charge capture, coding validation, and appropriate modifier usage prior to claim submission, while also monitoring claim status and following up on unpaid, denied, or underpaid claims. Additional responsibilities include researching and resolving claim denials, payment variances, and payer rejections; posting payments, adjustments, and contractual allowances; maintaining detailed documentation within billing systems; and communicating effectively with payers, patients, and internal departments to resolve billing issues. The role requires staying current on payer guidelines, billing regulations, and compliance standards, while consistently meeting departmental productivity and accuracy expectations. Candidates should have a high school diploma or equivalent, with an associate’s degree preferred, along with 1–3 years of hospital billing experience and strong knowledge of hospital billing workflows, UB-04 claims, and payer guidelines. Familiarity with CPT, HCPCS, and ICD-10 coding concepts, as well as experience with Medicare, Medicaid, and commercial insurance, is required. Strong attention to detail, analytical skills, and the ability to manage multiple priorities independently are essential, along with excellent written and verbal communication skills. Preferred qualifications include experience with inpatient and outpatient hospital billing, denial management and appeals, revenue cycle metrics, AR follow-up workflows, and certifications such as CPB or CPC. This role offers a collaborative, fast-paced healthcare environment with competitive compensation, a comprehensive benefits package including medical, dental, vision, PTO, and retirement options, and opportunities for professional growth and continuing education. Applicants must be legally authorized to work in the United States; sponsorship is not available.