The Billing Representative within Revenue Cycle Management performs day-to-day billing activities for Hospital (HB) and/or Medical Group (PB) claims, including claim generation and transmission. This role is responsible for primary, secondary, and tertiary billing, resolving claim edits and rejections, and ensuring claims are transmitted in compliance with payer guidelines. The Billing Representative serves as part of the Billing team to ensure timely, accurate, and compliant billing operations.
Duties and Responsibilities
- Demonstrate commitment to the Healthrise Core Values
- Perform daily billing activities, including resolving billing edits and rejected claims to ensure accurate and timely claim submission
- Identify routine billing issues and resolve or escalate them as appropriate
- Maintain working knowledge of state and federal laws related to insurance contracts and payer billing timelines
- Investigate and address overpayment and underpayment accounts to optimize reimbursement
- Apply payer rules, contracts, schedules, and related data to ensure claims are billed accurately and timely
- Research payer trends and provide feedback to improve billing accuracy and operational efficiency
- Track and report denial types and root causes, recommending process improvements
- Analyze, categorize, and resolve claim rejections from commercial, government, and managed care payers
- Document all actions and follow-up activities in the patient accounting system
- Respond to patient and payer inquiries or refer them appropriately
- Prepare and submit reports documenting billing trends, outcomes, and claim activity
- Interpret data, draw conclusions, and review findings with supervisor
- Cross-train in various functions to enhance service delivery
- Maintain knowledge of applicable federal, state, and local laws and regulations
- Perform other duties as assigned
Requirements & Qualifications
- High school diploma or associate degree in Accounting, Business Administration, or a related field
- 2 to 3 years of experience in revenue cycle medical billing, insurance follow-up, and denial management in a hospital, clinic, health insurance, managed care, or healthcare financial services environment
- Equivalent combination of education and experience may be considered
- Experience in a complex, multi-site healthcare system preferred
- Excellent written and verbal communication skills
- Strong organizational and time-management skills with high attention to detail and accuracy
- Strong interpersonal and customer service skills
- Basic proficiency in Microsoft Office (Outlook, Word, PowerPoint, Excel)
- Completion of regulatory and mandatory certifications preferred
- Comfortable working in a collaborative, shared-leadership environment
- Previous experience with Global Partner vendors preferred
- Experience using Epic
- Familiarity with CPT, ICD-10, and HCPCS coding
- Strong problem-solving skills
- Ability to work independently, meet deadlines, and maintain high attention to detail
- Certified Professional Biller (CPB), Certified Medical Reimbursement Specialist (CMRS), or equivalent certification preferred
Location
Michigan, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
1 month ago