Billing Specialist II

Community Health Systems, Inc.; United States; On-site; USD 48,000 - 68,000; Full time

Job summary

Community Health Systems, Inc. is seeking a Billing Specialist II to manage and audit insurance claims, rebill denied claims, and correct billing discrepancies within the electronic claims environment.

The role requires advanced knowledge of billing procedures, coding standards, and third-party payer requirements, and includes mentoring junior staff and ensuring timely, compliant submissions across departments.

Qualifications

• HS Diploma or GED required.
• Associate degree preferred in a related field (Business, Healthcare Administration, Medical Billing).
• 2–4 years of experience in medical billing, insurance claims processing, or revenue cycle operations required.
• Experience with hospital or physician billing, payer policies, and electronic billing systems preferred.

Responsibilities

• Processes and submits insurance claims via electronic and paper billing systems, ensuring accuracy and compliance.
• Reviews patient demographics, balances, and insurance information prior to claim generation and makes corrections.
• Identifies and resolves claim errors, denials, and rejections, rebilling within required timeframes.
• Monitors electronic billing processes, ensures successful claim downloads and timely follow-up on failures.
• Audits and assembles billing documentation, ensuring proper reimbursement and accuracy of claims.
• Demonstrates proficiency in revenue codes, HCPCS, CPT, UB-04, and CMS-1500 guidelines.
• Responds to payer inquiries with resolutions within two business days or escalates as needed.
• Maintains knowledge of third-party billing regulations and payer requirements to improve efficiency and compliance.
• Mentors and trains junior billing staff; collaborates with patient access, revenue cycle, and coding teams to prevent errors.

Skills

Advanced understanding of claim filing

Claims management systems

Coding knowledge HCPCS CPT

Denial management experience

Mentoring junior staff

MS Office & EHR proficiency

Strong communication

Education

Associate Degree in Business/Healthcare Admin/Medical Billing

H.S. Diploma or GED

Tools

Microsoft Office Suite

Job description

Job Summary

The Billing Specialist II is responsible for processing and auditing insurance claims, rebilling denied claims, and resolving billing discrepancies within the electronic claims management system. This role ensures accurate and timely claim submission, identifies and corrects billing errors, and maintains compliance with payer regulations and corporate policies. The Billing Specialist II demonstrates advanced knowledge of billing procedures, coding standards, and third-party payer requirements, serving as a mentor and resource for junior billing staff.

Essential Functions

• Processes and submits insurance claims via electronic and paper billing systems, ensuring accuracy, completeness, and compliance with payer-specific requirements.
• Reviews system account displays to verify patient demographics, balances, and insurance information prior to claim generation, making necessary corrections.
• Identifies and resolves claim errors, denials, and rejections, taking corrective action and rebilling claims within the required timeframe.
• Monitors electronic billing processes, ensuring successful claim downloads, accurate transmission, and timely follow-up on failed claims.
• Audits and assembles billing documentation, reviewing claims for completeness and applying modifications when needed to ensure proper reimbursement.
• Demonstrates proficiency in revenue codes, HCPCS, CPT coding, and payer billing guidelines, ensuring accurate claims processing and compliance with regulations.
• Responds to billing inquiries from internal departments and payers, providing resolution within two business days or escalating issues as needed.
• Maintains knowledge of third-party billing regulations, payer requirements, and automated resources to improve billing efficiency and compliance.
• Assists in mentoring and training junior billing staff, sharing expertise in claim resolution, billing requirements, and payer policies.
• Communicates with other departments, including patient access, revenue cycle, and coding teams, to ensure accurate billing information and prevent claim errors.
• Performs other duties as assigned.
• Maintains regular and reliable attendance.
• Complies with all policies and standards.

Qualifications

• H.S. Diploma or GED required
• Associate Degree in Business, Healthcare Administration, Medical Billing, or a related field preferred
• 2-4 years of experience in medical billing, insurance claims processing, or revenue cycle operations required
• Experience with hospital or physician billing, including payer policies, reimbursement processes, and electronic billing systems preferred

Knowledge, Skills and Abilities

• Advanced understanding of insurance claim processing, billing regulations, and reimbursement methodologies.
• Proficiency in electronic claims management systems, revenue codes, and medical coding standards (HCPCS, CPT, UB-04, CMS-1500).
• Strong problem-solving skills with the ability to analyze claim errors, identify trends, and implement corrective actions.
• Experience with payer-specific guidelines, denial management, and appeals processes.
• Ability to work independently and as a mentor to junior billing staff, demonstrating leadership and teamwork skills.
• Proficiency in Microsoft Office Suite (Excel, Outlook, Word) and electronic health record (EHR) systems.
• Strong written and verbal communication skills for interacting with payers, internal departments, and external partners.

Licenses and Certifications

• CPB- Certified Medical Biller preferred