Our Benefits
Comprehensive Health Coverage: Medical, dental, and vision plans to keep you
and your family healthy.
Competitive Pay & Full Benefits: A salary and package designed to reward your
expertise and dedication.
Paid time off
Flexible scheduling
Future Security: 401(k) with matching.
Job Summary
The Billing Specialist I is responsible for processing, auditing, and submitting
primary and secondary insurance claims, ensuring accuracy, compliance, and
timely reimbursement. This role utilizes electronic claims management systems to
review, correct, and resolve billing errors, denials, and rejections. The
Billing Specialist I collaborates with internal teams, facility liaisons, and
payers to ensure clean claim submission and adherence to federal, state, and
payer-specific regulations.
Essential Functions
Processes and submits primary and secondary insurance claims accurately and
in a timely manner, ensuring compliance with payer guidelines and regulatory
requirements.
Reviews and resolves claim errors, rejections, and denials, making necessary
corrections and resubmitting claims as needed.
Demonstrates working knowledge of billing forms, including UB-04, CMS-1500,
or state-specific billing forms, ensuring claims are submitted with the
appropriate documentation.
Audits claims for accuracy, checking for duplicate charges, overlapped
accounts, and missing information before submission.
Investigates and processes rebill requests, verifying claim accuracy and
making necessary updates per facility or coding liaison direction.
Maintains knowledge of billing regulations, payer policies, and electronic
submission guidelines, staying up to date with federal, state, and local
billing requirements.
Utilizes electronic billing systems to analyze, research, and transmit
claims, ensuring proper documentation of actions taken in the collection
system.
Monitors and reports charging or edit trends, collaborating with internal
teams (such as coding, patient access, and ancillary departments) to improve
billing accuracy.
Performs daily balancing tasks using SSI and other billing systems,
escalating unresolved issues or billing delays to the Billing Services
Manager.
Communicates professionally with payers, facility representatives, and
internal teams, ensuring efficient issue resolution and proper follow-up on
outstanding claims.
Performs other duties as assigned.
Maintains regular and reliable attendance.
Complies with all policies and standards.
Qualifications
H.S. Diploma or GED required
Associate Degree in Business, Healthcare Administration, Medical Billing, or
a related field preferred
0-1 years of experience in medical billing, insurance claims processing, or
revenue cycle operations required
1-3 years of billing experience in a medical facility, ambulatory surgery
facility, or acute-care preferred
Experience with hospital or physician billing, including knowledge of payer
policies and electronic claims systems preferred
Knowledge, Skills and Abilities
Basic understanding of insurance claim processing, medical billing, and
reimbursement guidelines.
Familiarity with billing software, electronic claims management systems
(e.g., SSI, Pulse/DAR), and eligibility tools.
Knowledge of CMS, Medicaid, Medicare, and commercial insurance billing
regulations.
Ability to analyze and resolve claim errors, denials, and rejections
efficiently.
Strong attention to detail, organizational skills, and ability to meet
deadlines.
Proficiency in Microsoft Office Suite (Excel, Outlook, Word) and electronic
health record (EHR) systems.
Excellent communication and problem-solving skills, with the ability to
interact professionally with internal teams and external payers.
Licenses and Certifications
CPB- Certified Medical Biller preferred
We know it’s not just about finding a job. It’s about finding a place where you
are respected, valued and where your work is purposeful and fulfilling. A place
where your talent is recognized, professional development is encouraged and
career advancement is possible.
The PPSI Team and Athena work alongside the Clinic Leaders and staff with the
common goal of creating a clean and efficient revenue cycle.
Community Health Systems is one of the nation's leading healthcare providers.
With healthcare delivery systems in 36 distinct markets across 14 states, CHS
operates 69 affiliated hospitals with more than 10,000 beds and approximately
1,000 other sites of care, including physician practices, urgent care centers,
freestanding emergency departments, imaging centers, cancer centers, and
ambulatory surgery centers.