Billing Specialist

Holy Cross Medical Center; Taos (NM); On-site; USD 42,000 - 64,000; Full time

Job summary

Holy Cross Medical Center is seeking a dedicated Claims Billing Specialist to ensure accurate and timely submission of insurance claims and robust follow-up. You will work with the Patient Financial Services Director and billing staff to maximize reimbursement while adhering to all federal and state requirements.

A strong background in denial management, appeals, and CAH reimbursement methodologies will help drive efficient revenue cycle operations.

Qualifications

• Knowledge of the back-end revenue cycle, including government and commercial insurance processes.
• Thorough understanding of medical billing and insurance collections.
• Ability to research and resolve complex outstanding claims through critical thinking and problem-solving.
• Experience with denial management, appeals, claim corrections, and reimbursement recovery.
• Excellent computer skills with proficiency in EHR systems, billing software, clearinghouses, Microsoft Office, and payer portals.
• Ability to communicate effectively with insurance representatives to resolve claim issues and negotiate reimbursement.
• Excellent verbal and written communication skills.
• Strong organizational, analytical, and time management skills.
• High attention to detail and ability to prioritize multiple tasks.

Responsibilities

• Handle accurate and timely submission of insurance claims and follow-up.
• Manage denial resolution, appeals, and reimbursement efforts.
• Collaborate with Patient Financial Services leadership, billing staff, and payers to ensure clean claims.
• Research complex claims and coordinate corrective actions with payers and internal teams.
• Maintain confidentiality and comply with regulatory guidelines.

Skills

Denial management

Appeals

Insurance follow-up

Billing accuracy

EHR proficiency

Billing software

Clearinghouses

Payer portals

Microsoft Office

Education

High school diploma or GED

Associate degree in Healthcare Administration/Business

Certified Professional Biller (CPB)

CAH reimbursement experience

Tools

EHR systems

Billing software

Clearinghouses

Payer portals

Microsoft Office

Job description

The Claims Billing Specialist is responsible for the accurate and timely billing and follow-up of insurance claims to maximize reimbursement while ensuring compliance with all federal, state, payer, and organizational guidelines. This position performs claim submission, insurance follow-up, denial management, appeals, and reimbursement resolution. The Claims Billing Specialist works collaboratively with the Patient Financial Services Director, Billing Supervisor, coding staff, and insurance payers to ensure clean claims and efficient revenue cycle operations.

Experience:

• Demonstrated experience with insurance billing, claim follow-up, denial management, and appeals.
• Working knowledge of CPT, HCPCS, ICD-10-CM coding, medical terminology, and payer billing requirements.

Education:

• High school diploma or GED required.
• Associate degree in Healthcare Administration, Business, or a related field.
• Professional certification such as Certified Professional Biller (CPB)
• Experience with Critical Access Hospital reimbursement methodologies and revenue cycle operations.

Mandatory Knowledge, Skills, Abilities and Other Qualifications:

• Knowledge of the back-end revenue cycle process, including government and commercial insurance processes.
• Thorough understanding of the medical billing and insurance collection process.
• Ability to research and resolve complex outstanding claims through critical thinking and problem-solving.
• Experience with denial management, appeals, claim corrections, and reimbursement recovery.
• Excellent computer skills with proficiency in electronic health record (EHR) systems, billing software, clearinghouses, Microsoft Office applications, and electronic payer portals.
• Ability to communicate effectively and professionally with insurance representatives to resolve claim issues and negotiate reimbursement when appropriate.
• Excellent verbal and written communication skills.
• Strong organizational, analytical, and time management skills.
• High attention to detail with the ability to prioritize multiple tasks and meet deadlines.
• Ability to work independently while contributing effectively as a member of the Patient Accounts team.
• Commitment to maintaining confidentiality and professionalism.

Preferred qualifications

• Minimum of three (3) years of medical billing experience in a Critical Access Hospital (CAH) preferred.