[Hiring] Hospital Biller II @Community Health System Services LLC

Role Description

As our next Hospital Biller II, you will drive revenue cycle performance by managing complex hospital billing activities, resolving payer-related issues, and minimizing reimbursement delays through advanced claim analysis and resolution. Serving as a subject matter resource within the billing team, you will independently resolve complex claim edits, denials, and billing exceptions while collaborating with coding, provider offices, credentialing, and revenue cycle partners. Through proactive identification of billing trends, process improvement recommendations, and a commitment to operational excellence, you will help improve clean claim performance, maximize reimbursement, and support the organization’s overall financial success.

What You'll Do Day-to-Day

• Claims Processing & Billing Operations:
  • Review and validate hospital claims to ensure accuracy, completeness, and compliance, supporting high clean-claim and first-pass acceptance rates.
  • Submit compliant, error-free claims electronically to government, commercial, and managed care payers to accelerate reimbursement and reduce denials.
  • Complete billing of hospital services within required timeframes to maintain timely revenue capture and prevent aging delays.
  • Rebill corrected claims quickly and accurately to minimize payment delays and ensure proper reimbursement.
  • Prioritize and manage assigned work queues efficiently to maintain steady claim throughput and prevent backlogs.
  • Perform analysis of recurring denial and rejection trends and recommend corrective actions to reduce further recurrence.
  • Provide peer support and workflow guidance to less experienced team members.
• Claim Resolution & Revenue Cycle Optimization:
  • Monitor billing work queues proactively, resolving claim edits promptly to avoid submission bottlenecks and maintain workflow efficiency.
  • Analyze and resolve claim rejections and front-end edits to reduce rework, improve payer acceptance, and strengthen revenue cycle performance.
  • Escalate complex billing or payer issues appropriately to support timely resolution and prevent prolonged claim aging.
• Collaboration & Cross-Functional Support:
  • Collaborate with registration, credentialing, and provider offices to obtain missing or corrected information, ensuring claims meet payer requirements.
  • Communicate effectively with internal departments to streamline claim resolution and support cross-functional workflow efficiency.
• Compliance, Documentation & Privacy:
  • Maintain strict compliance with federal, state, payer, and organizational billing guidelines to reduce audit risk and ensure regulatory adherence.
  • Protect patient information by following HIPAA and organizational privacy standards, ensuring secure handling of all Protected Health Information (PHI).
  • Maintain comprehensive documentation of claim activity, payer communications, appeal actions, and resolutions.
• Performance & Quality Management:
  • Meet or exceed productivity, quality, denial resolution, and account aging performance standards.
  • Utilize critical thinking and payer knowledge to identify trends, address recurring claim issues, and support continuous improvement in billing performance.
• Professional Development & Process Improvement:
  • Participate in departmental meetings, training, and process improvement initiatives to enhance skills, support operational improvements, and stay current with regulatory changes.

Qualifications

• Advanced knowledge of hospital billing, claims processing, denial management, and reimbursement methodologies.
• Strong understanding of CPT, HCPCS, ICD-10-CM, and payer billing requirements.
• Familiarity with electronic claim submission and billing work queues.
• Strong attention to detail and organizational skills.
• Ability to analyze claim errors and identify appropriate corrective actions.
• Strong problem-solving, critical-thinking, and analytical skills.
• Excellent organization and communication skills.
• Proficiency in Microsoft Office applications.
• Ability to train team members while maintaining productivity standards.
• Proficiency with Epic Hospital Billing preferred.

Requirements

• Associate’s degree in a related field preferred; alternatively, a High School Diploma or GED with an additional two years of related experience.
• Certified Biller credential preferred but not required.
• Associate’s degree with five (5) years of billing experience in a medical billing environment, or a High School Diploma with seven (7) years of billing experience in a medical billing environment; Epic experience preferred.

Physical Readiness

• Ability to perform the essential functions of the position with or without reasonable accommodation, including prolonged sitting and computer use, frequent keyboarding, occasional standing, walking, bending, and lifting or moving items up to 20 pounds, and sufficient visual acuity to review electronic documents, reports, and financial data.