IL - Billing Specialist

Job Title: Billing Specialist

POSITION SUMMARY

The Billing Specialist is responsible for the accurate and timely submission of claims to government and commercial payers across all service lines of the hospital complex, including facility (UB-04) and professional/clinic (CMS-1500) billing. This role ensures compliance with payer-specific requirements and CAH billing guidelines to maximize reimbursement and minimize denials.

ESSENTIAL FUNCTIONS

1. Prepare and submit clean UB-04 and CMS-1500 claims to Medicare, Medicaid, commercial, and other payers across all service lines in a timely manner.

2. Verify insurance eligibility and benefit information as part of the pre-billing process.

3. Review claims for accuracy of codes, modifiers, revenue codes, patient demographics, and payer-specific edits within TruBridge.

4. Monitor TruBridge claim edit and hold queues and resolve errors prior to submission.

5. Conduct follow-up on unpaid, rejected, or pending claims and initiate appropriate corrective action.

6. Maintain current knowledge of CAH billing requirements, swing bed billing, Medicare cost-based reimbursement, and payer-specific guidelines.

7. Document all billing activity and account notes accurately and timely in TruBridge.

8. Assist with month-end reporting and reconciliation as directed by the Business Office Manager.

NON-ESSENTIAL FUNCTIONS

• Perform other duties as assigned by the Director, CBO or HIM Manager.

Assist with cross-training and support of other CBO staff as needed.

MINIMUM QUALIFICATIONS

Education:

• High school diploma or equivalent required

Associate's degree in a related field preferred

Experience:

Minimum 1-2 years of medical billing experience

Hospital or Critical Access Hospital billing experience preferred

Knowledge, Skills, and Abilities:

Knowledge of CPT, ICD-10, HCPCS coding, and revenue codes

Familiarity with UB-04 and CMS-1500 claim formats and Medicare/Medicaid billing requirements

Experience with TruBridge or comparable community hospital EHR/PM system preferred

Strong attention to detail, organizational skills, and ability to meet deadlines

Proficiency in Microsoft Office Suite

PREFERRED QUALIFICATIONS

Experience with multi-service line facility billing including SNF, swing bed, and outpatient services

LICENSES AND CERTIFICATIONS

Preferred: CPB (Certified Professional Biller) or CPC

Physical Requirements:

The physical demands described below are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Constantly (67-100% of the time): Sitting, Talking/ Hearing, Near Visual Acuity
• Frequently (34-66% of the time): Repetitive Hand/ Wrist Motion
• Occasionally (11-33% of the time):Walking, Standing
• Rarely (less than 10% of the time): Bending/Stooping, lifting/carrying (up to 25 lbs)

WORK ENVIRONMENT

Work is performed in a professional administrative/office environment within a healthcare facility. The employee may work in proximity to patient care areas. Standard office lighting, temperature, and noise levels apply. Occasional movement between departments and buildings within the hospital complex may be required. Remote or hybrid work arrangements may be considered based on organizational policy and performance.