Job Summary
The Billing Specialist II (REMOTE) is responsible for processing and auditing insurance claims, rebilling denied claims, and resolving billing discrepancies within the electronic claims management system. This role ensures accurate and timely claim submission, identifies and corrects billing errors, and maintains compliance with payer regulations and corporate policies. The Billing Specialist II demonstrates advanced knowledge of billing procedures, coding standards, and third-party payer requirements, serving as a mentor and resource for junior billing staff.
As a Billing Specialist II at Community Health Systems (CHS) – SSC Nashville, you’ll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including medical, dental and vision, insurance, and 401k.
Essential Functions
- Processes and submits insurance claims via electronic and paper billing systems, ensuring accuracy, completeness, and compliance with payer-specific requirements.
- Reviews system account displays to verify patient demographics, balances, and insurance information prior to claim generation, making necessary corrections.
- Identifies and resolves claim errors, denials, and rejections, taking corrective action and rebilling claims within the required timeframe.
- Monitors electronic billing processes, ensuring successful claim downloads, accurate transmission, and timely follow-up on failed claims.
- Audits and assembles billing documentation, reviewing claims for completeness and applying modifications when needed to ensure proper reimbursement.
- Demonstrates proficiency in revenue codes, HCPCS, CPT coding, and payer billing guidelines, ensuring accurate claims processing and compliance with regulations.
- Responds to billing inquiries from internal departments and payers, providing resolution within two business days or escalating issues as needed.
- Maintains knowledge of third-party billing regulations, payer requirements, and automated resources to improve billing efficiency and compliance.
- Assists in mentoring and training junior billing staff, sharing expertise in claim resolution, billing requirements, and payer policies.
- Communicates with other departments, including patient access, revenue cycle, and coding teams, to ensure accurate billing information and prevent claim errors.
- Performs other duties as assigned.
- 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
- 2-4 years of experience in medical billing, insurance claims processing, or revenue cycle operations required
- Experience with hospital or physician billing, including payer policies, reimbursement processes, and electronic billing systems preferred
Knowledge, Skills and Abilities
- Advanced understanding of insurance claim processing, billing regulations, and reimbursement methodologies.
- Proficiency in electronic claims management systems, revenue codes, and medical coding standards (HCPCS, CPT, UB-04, CMS-1500).
- Strong problem-solving skills with the ability to analyze claim errors, identify trends, and implement corrective actions.
- Experience with payer-specific guidelines, denial management, and appeals processes.
- Ability to work independently and as a mentor to junior billing staff, demonstrating leadership and teamwork skills.
- Proficiency in Microsoft Office Suite (Excel, Outlook, Word) and electronic health record (EHR) systems.
- Strong written and verbal communication skills for interacting with payers, internal departments, and external partners.
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 Shared Services Center – Nashville provides business office support functions like billing, insurance follow-up, call center customer service, data entry and more for hospitals and healthcare providers. But we’re not only about work. We know employing a skilled and engaged team of professionals is vitally important to our success, so we make sure to offer competitive benefits, recognition programs, professional development opportunities and a fun and engaging team environment.
Community Health Systems is one of the nation’s leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.
