Medical Hospital Billing Specialist

Job Title: Medical Hospital Billing Specialist

Location: On-site / Hybrid / Remote
Department: Revenue Cycle / Patient Financial Services
Employment Type: Full-Time 

Position Summary

The Medical Hospital Billing Specialist is responsible for accurate and timely billing of hospital services to insurance payers and patients. This role plays a critical part in the revenue cycle by ensuring claims are submitted correctly, payments are posted appropriately, and accounts are resolved efficiently while maintaining compliance with payer and regulatory requirements.

Key Responsibilities

• Prepare, review, and submit hospital claims (inpatient, outpatient, and/or ancillary services) to commercial, Medicare, and Medicaid payers

• Verify patient insurance coverage, authorizations, and benefits as needed

• Ensure accurate charge capture, coding validation, and modifier usage prior to claim submission

• Monitor claim status and follow up on unpaid, denied, or underpaid claims

• Research and resolve claim denials, payment variances, and payer rejections

• Post payments, adjustments, and contractual allowances accurately

• Maintain detailed account notes and documentation in the billing system

• Communicate effectively with payers, patients, and internal departments to resolve billing issues

• Stay current on payer guidelines, billing regulations, and compliance requirements

• Meet productivity and accuracy standards established by the department

Qualifications

• High school diploma or equivalent required; associate’s degree preferred

• Minimum of [1–3] years of hospital billing experience required

• Strong knowledge of hospital billing processes, UB-04 claims, and payer guidelines

• Familiarity with CPT, HCPCS, ICD-10 coding concepts

• Experience with Medicare, Medicaid, and commercial insurance payers

• Proficiency with electronic health records (EHR) and billing systems

• Strong attention to detail and analytical skills

• Ability to manage multiple priorities and work independently

• Excellent written and verbal communication skills

Preferred Qualifications

• Experience in inpatient and outpatient hospital billing

• Knowledge of denial management and appeals

• Familiarity with revenue cycle metrics and AR follow-up workflows

• Certification such as CPB, CPC, or equivalent (preferred but not required)

Work Environment & Benefits

• Collaborative, fast-paced healthcare environment

• Competitive compensation based on experience

• Comprehensive benefits package including medical, dental, vision, PTO, and retirement options

• Opportunities for professional growth and continuing education

  **Applicants must be legally authorized to work in the United States. We are unable to sponsor or take over sponsorship of an employment visa at this time.