Responsible for evaluating and resolving barriers that prevent accurate and timely hospital claim submission. This role applies working knowledge of Medicare, Medicaid, managed care, and commercial payer requirements across the claim-generation lifecycle, including edits, claim splits, bill holds, rejections, late charges, and other exceptions.
Works collaboratively with billing, operational, clinical, reimbursement, and technology teams to improve first-pass clean-claim performance, reduce DNFB, and accelerate revenue capture.
Key responsibilities include:
- Supporting the hospital claim-generation lifecycle from final coding and charge capture through claim creation, validation, and transmission
- Researching and resolving billing edits, claim splits, bill holds, rejections, late charges, stop bills, and other exceptions
- Analyzing recurring claim barriers and identifying root causes across processes, system configuration, payer rules, and upstream workflows
- Monitoring first-pass clean-claim rate, bill-hold days, DNFB, rejection trends, and billing throughput
- Documenting billing scenarios, root causes, recommended actions, and reusable guidance
- Partnering with internal and vendor teams to improve edits, work queues, workflows, and escalation processes
2–3 years of hospital billing experience, including hands-on experience resolving claims before submission.
Required qualifications and experience:
- Working knowledge of the end-to-end institutional claim lifecycle
- Experience with claim edits, split-billing scenarios, bill holds, rejections, late charges, stop bills, and corrected or replacement claims
- Knowledge of Medicare, Medicaid, managed care, and commercial payer billing rules, claim formats, and submission requirements
- Familiarity with UB-04 and 837I requirements, revenue codes, bill types, condition and occurrence codes, modifiers, claim frequency codes, and payer-specific edits
- Ability to research why a claim cannot be released and determine the appropriate resolution or escalation path
- Proficiency in Excel and comfort reviewing billing, edit, hold, and rejection data for trends
- Clear written and verbal communication skills with a collaborative, consultative approach
- Experience researching claim-generation issues in Epic Resolute or a comparable patient accounting system
- Experience using clearinghouse tools, payer portals, claim scrubbers, and reporting tools
- Exposure to multiple hospitals, facilities, or payer environments
- Experience sharing billing guidance or helping team members work through claim issues
Location
N/A
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
1 month ago