Hospital Billing Edit Resolution Specialist

Catholic Health; Buffalo (NY); Hybrid; USD 55,000 - 75,000; Full time

Job summary

Catholic Health seeks a Coding Billing Edit Resolution Specialist to provide hospital billing support by reviewing and resolving pre-bill edits and denials in Medicare and third‑party payer accounts. You will apply coding rules, payor policies, and billing regulations with attention to detail.

The role requires a coding credential (CPC/CCS or RHIT/RHIA with experience) and strong organizational, time-management, and communication skills.

Qualifications

• Must have calm and pleasant demeanor when working with provider offices
• Detail oriented with ability to manage multiple priorities concurrently
• Strong keyboarding skills and computer proficiency
• Knowledge of coding rules, payor policies and billing regulations

Responsibilities

• Review and resolve pre-bill edits and denials for Medicare and third‑party payers
• Apply coding rules, NCDs, LCDs and billing regulations to ensure accurate claims
• Maintain understanding of payor payment policies and documentation requirements

Skills

Attention to detail

Time management

Verbal communication

Organizational skills

Confidentiality

Prioritization

Education

CPC or CCS credential

RHIT or RHIA with 5 years coding experience

High school diploma

Tools

Epic

Job description

Facility: Administrative Regional Training Cntr

Shift: Shift 1

Status: Full Time

FTE: 1.000000

Bargaining Unit: ACE Associates

Exempt from Overtime: Exempt: No

Work Schedule: Days

Hours: 8-4

Summary

Under the direction of the Manager of Patient Financial Services and working together with the audit appeals specialist, the Coding Billing Edit Resolution specialist provides hospital billing support services through efficient review and timely resolution of assigned Medicare and third‑party payer accounts that are subject to pre‑bill claim edits, hospital bill hold edits and claim denials. These edits include, but are not limited to, CCI, MUE, medical necessity edits and a myriad of payor payment policies. This position requires a thorough knowledge of coding rules and regulations, medical record documentation, payor payment policies, NCDs, LCDs, CMS Coverage Articles and billing regulations. This position also requires a coding credential.

Education

• High school graduate
• Additional post‑secondary education preferred
• Coding Credential of a CPC or CCS is required. Consideration will be given to candidates with an RHIT or RHIA credential that have at least five years coding experience

Experience

• Three years' experience with hospital outpatient or professional coding
• Healthcare billing experience is preferred
• Experience with interpreting and applying payor payment policies is preferred
• Epic experience is preferred

Knowledge, Skill and Ability

• Must have calm and pleasant demeanor when working with provider offices
• Must be detail oriented and be able to manage multiple priorities concurrently
• Computer proficiency with strong keyboarding skills
• Visual acuity to read medical record documentation and payor websites
• Strong verbal communication skills
• Strong organizational skills
• Solid time management skills
• Understands and maintains confidential nature of information handled and discussed
• Ability to apply judgment independently and prioritize tasks without daily coaching or direction

Working Conditions

• Works in office setting and remotely with a laptop computer
• Sits for prolonged periods of time, in front of a computer screen

Environment

• Normal heat, light space, and safe working environment; typical of most office jobs
• May have frequent interruptions when providing onsite education at busy clinic locations
• Occasional exposure to one or more mildly unpleasant physical conditions