Physician Billing Representative II

Christiana Care Health Services, Inc.; United States; On-site; USD 32,000 - 47,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Retirement

Employee assistance program

Job summary

Christiana Care Health System seeks a denials specialist to review, analyze, and act on payer denials. You will communicate with payers, medical practices, hospital departments, and patients to gather data and drive resolution of unpaid balances.

Responsibilities include researching authorizations, rebilling, write-offs or transfers, following up with insurance carriers, and ensuring accurate CPT4/ICD10 coding.

Qualifications

• Thorough understanding of revenue cycle processes from patient access to billing and collections.
• Knowledge of medical terminology and physician billing policies.
• Familiarity with CPT4 and ICD10 coding in physician billing.

Responsibilities

• Review denial/work queues to resolve uncollected balances.
• Research authorizations, rebilling, and balance write-off or transfer of charges.
• Escalate issues as appropriate and follow-up with payers.
• Follow up with insurance carriers to obtain payment status and resolve claims.
• Review coverage changes and rebill charges as needed.
• Assign payer plans and update registration information.
• Ensure CPT4/ICD10 coding accuracy in encounters and claims.
• Ensure claims have complete billing information.
• Meet productivity benchmarks.
• Submit required documents to third-party payers for payment.
• Review payment vouchers for proper reimbursement.
• Resolve patient insurance discrepancies with office staff.
• Submit claims timely to insurers.
• Adhere to safety rules and report hazards.
• Perform related duties as required.

Skills

Revenue cycle knowledge

Medical terminology

CPT4/ICD10 coding

Physician billing

Written communication

Independence

Judgement and tact

Education

High school diploma or equivalent

Associate degree preferred

Tools

Epic experience

Job description

PRIMARY FUNCTION

Responsible for reviewing, analyzing and initiating appropriate action for denial resolution by communicating with payers, medical practices, hospital departments and patients for data as assigned. Responsible for follow up with third-party insurance companies to resolve unpaid account balances. Focus on specialty payers including military, correctional facilities, assault victims and hospice.

PRINCIPAL DUTIES AND RESPONSIBILITIES

• Work accounts in assigned denial and no response work queues (WQs) to resolve uncollected account balances.
• Complete appropriate action needed for an effective resolution including conducting authorization research, rebilling, and balance write off or transfer to next responsible party.
• Escalates issues as appropriate.
• Perform follow-up with insurance carriers to obtain payment status and resolve claims issues within timely filing compliance.
• Reviews coverage changes made by other system users to determine if new or removed coverages, changed filing orders, or updated effective dates should be applied to previously billed, paid or adjusted charges in order to re-bill the charges.
• Assigns appropriate payer plans to facilitate billing and updates registration information when necessary.
• Reviews all encounter documents for completeness and proper CPT4/ICD10 coding as it relates to physician billing.
• Ensure claims have all necessary billing information.
• Meet departmental productivity benchmarks.
• Performs follow-up with insurance carriers to obtain payment status and resolve claim issues.
• Submits the appropriate documentation to third party payers to secure payment on claims.
• Reviews payment vouchers to ensure proper reimbursement.
• Resolves patient insurance discrepancies with office staff at physicians’ offices.
• Review and submit claim forms to third party insurance companies timely.
• Performs assigned work safely, adhering to established departmental safety rules and practices; reports to supervisor, in a timely manner, any unsafe activities, conditions, hazards, or safety violations that may cause injury to oneself, other employees, patients and visitors.
• Performs other related duties as required.

SCOPE, PURPOSE, AND FREQUENCY OF CONTACTS

Frequent contact with Christiana Care staff. Physician office staff, patients and third party payers.

DIRECTION/SUPERVISION OF OTHERS

None.

DIRECTION/SUPERVISION RECEIVED

Operations Coordinator and/or Billing Manager

EDUCATION AND EXPERIENCE REQUIREMENTS

High school graduate or equivalent. Associate’s degree preferred. Three to five (3-5) years of physician billing/coding experience preferably in a computerized physician billing department or large physician group practice, Epic experience preferred. An equivalent combination of experience and education may be substituted. Prior experience with and understanding CARC/RARC codes.

KNOWLEDGE, SKILL, AND ABILITY REQUIREMENTS

Thorough understanding of revenue cycle process, from patient access (authorizations, admissions) through Patient Financial Services (billing, insurance appeals, collections) procedures and policies. Knowledge of medical terminology. Knowledge of physician billing and reimbursement policies and procedures. Knowledge of CPT4 and ICD10 codes as it relates to physician billing. Knowledge of physician office practices. Ability to enter, update, and retrieve information using a personal computer. Skill in written and oral communication. Ability to act independently within established guidelines. Ability to exercise judgement and tact.

SPECIAL REQUIREMENTS

None.

PHYSICAL DEMANDS

Intermittent sitting, standing, and walking. Light lifting and moving Manual dexterity to initiate calls and provide computer entry. Sight to dial numbers and read computer screens.

WORKING CONDITIONS

Sits or stands most of the day in an office environment.

Hourly Pay Range

Hourly Pay Range: $22.74 - $34.11 This pay rate/range represents ChristianaCare’s good faith and reasonable estimate of compensation at the time of posting. The actual salary within this range offered to a successful candidate will depend on individual factors including without limitation skills, relevant experience, and qualifications as they relate to specific job requirements.

EEO Posting Statement

Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.

BENEFITS

ChristianaCare offers a competitive suite of employee benefits to maximize the wellness of you and your family, including health insurance, paid time off, retirement, an employee assistance program.

• health insurance
• paid time off
• retirement
• employee assistance program

LOCATION

Christiana Hospital, Newark, Delaware.

Post End Date

Oct 23, 2026

This 1,007-bed, 1.3-million-square-foot modern facility provides a level of care only available in large-scale teaching hospitals. Christiana Hospital includes Delaware's only Level-I Trauma center (as verified by the American College of Surgeons), which is prepared to handle the most extreme medical emergencies. In fact, it is the only Level-I Trauma center on the East Coast corridor between Baltimore and Philadelphia. Christiana Hospital has also been nationally recognized in U.S. News & World Report's Best Regional Hospitals rankings as #1 in Delaware and #3 in the Philadelphia metro area, plus High Performing in 9 Adult Procedures/Conditions Christiana Care Health System Website