Medical Biller

Hospital Billing Specialist Primary location for this position is in Colfax, WA.Standard Expectations Promotes a Positive Working EnvironmentConducts oneself in line with organization's mission, values and standards of behavior.Accepts change and challenges with a positive attitude.Consistently adheres to organizational policy.Communicates EffectivelyBuilds relationships and works collaboratively with other staff.Provides timely operational updates to supervisor.Responds to communications in a timely manner.Performs Duties Efficiently and EffectivelyFollows procedures.Acts in compliance with applicable federal, state, and local regulations.Performs other duties as assigned.Area of Responsibility Duties & Responsibilities Hospital Billing & Claims SubmissionPrepare, review, and submit hospital (UB-04) claims for inpatient and outpatient services using Epic HB.Ensure claims comply with Critical Access Hospital Medicare billing rules, including cost-based reimbursement requirements.Review claim edits, billing holds, and Epic HB workqueues; resolve issues prior to claim submission.Submit corrected, replacement, late charge, and adjustment claims as appropriate.Coordinate timely secondary and tertiary billing following Medicare primary payment.Accounts Receivable & Payer Follow-UpPerform payer follow-up on unpaid, underpaid, or denied hospital claims.Analyze remittance advice (ERA/EOB) to ensure accurate payment and identify underpayments.Work denials related to medical necessity, coding, charging, registration, authorizations, and timely filing.Initiate appeals, reconsiderations, and reopenings in accordance with payer and CMS guidelines.Escalate complex reimbursement issues to the Senior Manager of Billing & Reimbursement as appropriate.Denials Management & Revenue ProtectionResearch and resolve hospital billing denials using Epic documentation, coding review, and clinical validation.Identify root causes of recurring denials and collaborate with coding, clinical departments, and front-end teams to prevent reoccurrence.Maintain clear and compliant account documentation within Epic.Support denial trending and performance improvement initiatives.Epic HB System ResponsibilitiesUtilize Epic HB workqueues, dashboards, and reporting tools to manage daily billing and A/R workload.Maintain accurate account notes, claim statuses, and follow-up actions in Epic.Identify Epic workflow issues or system errors impacting billing and reimbursement.Participate in Epic upgrades, testing, and optimization efforts related to hospital billing and reimbursement.Compliance, Audit & Reimbursement SupportEnsure billing practices comply with CMS, Medicare, Medicaid, and payer regulations.Support audits, payer reviews, and medical record requests related to hospital claims.Assist leadership with data gathering and documentation related to cost report preparation and reimbursement analysis.Adhere to hospital policies, HIPAA requirements, and billing compliance standards.Team Support & Cross-CoverageProvide cross-coverage within the Patient Financial Services or Patient Access teams as needed.Assist with patient billing inquiries related to hospital accounts in a professional and compassionate manner.Participate in department meetings, training, and performance improvement initiatives.Qualifications RequiredHigh school diploma or GED.Minimum of 2 years of hospital billing experience.Strong understanding of UB-04 claims, revenue codes, and hospital billing workflows.Strong computer skills in data entry, and knowledge of Electronic Medical Record software; Microsoft Office SuitePreferredExperience billing Medicare and Medicaid hospital claims strongly preferred.Working knowledge of Epic HB strongly preferred.Experience billing in a Critical Access HospitalKnowledge of ICD-10-CM/PCS and hospital charging concepts.Experience with hospital denial management and payer appeals.Associate's degree in healthcare administration, business, or related field.Completion of medical billing terminology coursesIf you are looking for a rewarding career with a great team, you'll enjoy your career with us!Position Details Hours per week: 40Employee Status: Regular Full TimeShift: Day Shift (United States of America)Pay Range: $21.00 - $36.75Actual pay offered will vary based on years of experience.Employee Benefits Our benefit package includes medical, dental, vision, life insurance, and retirement options (403(b) & 457). Medical insurance coverage begins on day one and is available to both full time and part time employees. Additionally, employees receive discounts on medical services provided by Whitman Hospital and Medical Clinics. Differentials apply for evening, night, and weekend shifts. Our unique PTO plan enables employees to increase their accrual with each year of service!