Medical Claims & Billing Specialist: Revenue Integrity

Blanchard Valley Health System; Dayton (OH); On-site; USD 42,000 - 64,000; Full time

Job summary

Blanchard Valley Health System is seeking a Medical Claims Specialist to manage pre-billing and follow-up, ensuring clean claims and prompt payer reimbursement. The role emphasizes accurate data collection, error resolution, and collaboration with hospital departments to enable timely billing.

The candidate should be proficient in Excel and familiar with HIPAA regulations, with the ability to handle multiple tasks, prioritize claims, and communicate effectively with payers and internal teams.

Qualifications

• High school diploma or GED required.
• CPFSS certification within 12 months of hire; PRN status does not require certification.
• Familiarity with medical terminology and HIPAA requirements.
• Proficient in Microsoft Office Programs, especially Excel.
• Ability to manage multiple tasks with strong time management and organizational skills.
• Demonstrated problem solving skills and self-direction.

Responsibilities

• Maintains compliant claims submission practices with relevant regulations.
• Accurately and efficiently processes daily electronic billing files to obtain clean first-time reimbursement.
• Corrects claim issues prior to submission by verifying demographics, insurance eligibility, and authorizations.
• Submits manual claims for payers not accepting electronic submissions.
• Monitors error reports to identify trends and improve processes.
• Escalates outstanding holds and communicates findings to supervisor.
• Attends staff meetings and ongoing education to maintain certifications.

Skills

Medical terminology

HIPAA compliance

Excel

Time management

Problem solving

Attention to detail

Communication

Education

High school diploma or GED

CPFSS certification within 12 months

Associate's degree

CPC certification

Tools

Billing system software

Excel

CMS-1500 forms

Job description

Blanchard Valley Health System is seeking a Medical Claims Specialist to manage pre-billing and follow-up, ensuring clean claims and prompt payer reimbursement. The role emphasizes accurate data collection, error resolution, and collaboration with hospital departments to enable timely billing.

The candidate should be proficient in Excel and familiar with HIPAA regulations, with the ability to handle multiple tasks, prioritize claims, and communicate effectively with payers and internal teams.