Billing Representative

Job Description

Job Description

Description:

The Billing Representative within Revenue Cycle Management performs day-to-day billing activities for Hospital (HB) and/or Medical Group (PB) claims, including claim generation and transmission. This role is responsible for primary, secondary, and tertiary billing, resolving claim edits and rejections, and ensuring claims are transmitted in compliance with payer guidelines. The Billing Representative serves as part of the Billing team to ensure timely, accurate, and compliant billing operations.

• Demonstrates knowledge of and commitment to the Healthrise Core Values
• Performs daily billing activities, including resolving billing edits and rejected claims to ensure accurate and timely claim submission
• Identifies routine billing issues and resolves or escalates them as appropriate
• Maintains working knowledge of state and federal laws related to insurance contracts and payer billing timelines
• Investigates and addresses overpayment and underpayment accounts to optimize reimbursement
• Applies payer rules, contracts, schedules, and related data to ensure claims are billed accurately and timely
• Researches payer trends and provides feedback to improve billing accuracy and operational efficiency
• Tracks and reports denial types and root causes, recommending process improvements
• Analyzes, categorizes, and resolves claim rejections from commercial, government, and managed care payers
• Documents all actions and follow-up activities in the patient accounting system
• Responds to patient and payer inquiries or refers them appropriately
• Prepares and submits reports documenting billing trends, outcomes, and claim activity
• Interprets data, draws conclusions, and reviews findings with supervisor
• Cross-trains in various functions to enhance service delivery
• Maintains knowledge of applicable federal, state, and local laws and regulations
• Performs other duties as assigned

Required

• High school diploma or Associate degree in Accounting, Business Administration, or a related field
• Minimum of two (2) to three (3) years of experience in revenue cycle medical billing, insurance follow-up, and denial management within one of the following settings:
  • Hospital or clinic
  • Health insurance company or managed care organization
  • Healthcare financial services environment
• Equivalent combination of education and experience may be considered
• Experience in a complex, multi-site healthcare system preferred
• Excellent written and verbal communication skills
• Strong organizational and time-management skills with high attention to detail and accuracy
• Strong interpersonal and customer service skills
• Basic proficiency in Microsoft Office (Outlook, Word, PowerPoint, Excel)
• Completion of regulatory and mandatory certifications preferred
• Comfortable working in a collaborative, shared-leadership environment
• Previous experience with Global Partner vendors preferred
• Experience using Epic
• Familiarity with CPT, ICD-10, and HCPCS coding
• Strong problem-solving skills
• Ability to work independently, meet deadlines, and maintain high attention to detail

• Certified Professional Biller (CPB), Certified Medical Reimbursement Specialist (CMRS), or equivalent certification

• Work Environment: This position operates in a professional home environment and routinely uses standard office equipment, including computers and phones
• Physical Demands: This role is primarily sedentary and requires regular use of a keyboard, mouse, and other devices for typing, clicking, and navigating software systems