Medical Billing Specialist: Claims & Reimbursement

Blanchard-Valley-Health-System; Findlay (OH); On-site; USD 38,000 - 52,000; Full time

Job summary

Blanchard-Valley-Health-System seeks a Medical Claims Specialist to manage all aspects of claims, from pre-billing validation to follow-up, ensuring accurate, timely reimbursement. Collaboration with hospital departments helps ensure complete documentation and compliance.

The role emphasizes accurate data, payer communications, and adherence to HIPAA and regulatory requirements while promoting efficient revenue cycle processes.

Qualifications

• High school diploma or GED required.
• CPFSS certification within 12 months of hire.
• Familiarity with medical terminology and HIPAA requirements.
• Ability to manage multiple tasks and collaborate with others.
• Proficient in Microsoft Office, especially Excel.
• Strong time management and organizational skills.
• Valid driver's license and ability to operate a vehicle per BVHS policy.
• Knowledge to provide age-appropriate patient care and growth/development awareness.

Responsibilities

• Maintains HIPAA compliance and payer policy knowledge to enable compliant claims submission.
• Process daily electronic billing file to achieve clean first-time reimbursement.
• Corrects claims issues before submission by verifying demographics and eligibility.
• Educates staff when documentation is insufficient for billing.
• Prepares and submits manual claims for payers not accepting electronic claims.
• Monitors error reports to identify trends and process improvements.
• Monitors billing holds, escalates when needed, and reports trends to supervisor.
• Observes best-practice billing, follow-up, and customer service; reports compliance concerns.
• Identifies high-risk accounts and prioritizes follow-up with payors to secure timely payment.

Skills

HIPAA compliance

Excel

Time management

Organizational skills

Problem solving

Multitasking

Education

High school diploma or GED

CPFSS certification within 12 months

Tools

Microsoft Excel

Billing system

Job description

Blanchard-Valley-Health-System seeks a Medical Claims Specialist to manage all aspects of claims, from pre-billing validation to follow-up, ensuring accurate, timely reimbursement. Collaboration with hospital departments helps ensure complete documentation and compliance.

The role emphasizes accurate data, payer communications, and adherence to HIPAA and regulatory requirements while promoting efficient revenue cycle processes.