Hybrid Patient Financial Services Specialist

100 Stormont-Vail HealthCare, Inc.; United States; On-site; USD 45,000 - 65,000; Full time

Job summary

100 Stormont-Vail HealthCare, Inc. is seeking a Full-time Billing Specialist to coordinate complex claim submissions and optimize the revenue cycle. You will work closely with clinical departments and third-party payors to ensure accurate submissions and timely reimbursements.

The role emphasizes analyzing denials, coordinating appeals for medical necessity, and driving process improvements to reduce denials and improve customer satisfaction, in compliance with federal and state regulations.

Qualifications

• Knowledge of major third-party billing and contract requirements.
• Working knowledge of basic medical terminology.
• Understanding of medical/clinical treatment processes.
• Superior written and oral communication skills.

Responsibilities

• Generates re-bills after all edits have been resolved and re-submits claims to third-party payors.
• Identifies missing or incorrect requirements of rejected claims and forwards for resolution.
• Completes manual billing process for claims that cannot be sent electronically.
• Identifies and resolves all electronic claim edit failures in a timely manner.
• Works with clearinghouse for correction and compliance of edits.
• Writes appeals to obtain payment or coordinates with clinical departments to write appeals for medical necessity.

Skills

Billing knowledge

Medical terminology

Regulatory compliance

Communication skills

Excel/analytical

Numerical proficiency

Education

High School Diploma / GED

Bachelor's degree in Business/Accounting/Finance

Job description

100 Stormont-Vail HealthCare, Inc. is seeking a Full-time Billing Specialist to coordinate complex claim submissions and optimize the revenue cycle. You will work closely with clinical departments and third-party payors to ensure accurate submissions and timely reimbursements.

The role emphasizes analyzing denials, coordinating appeals for medical necessity, and driving process improvements to reduce denials and improve customer satisfaction, in compliance with federal and state regulations.