Billing Specialist

Hoskinson Biotechnology•Gillette, WY

About The Position

The Billing Specialist is responsible for auditing, monitoring, and optimizing billing processes within assigned clinical departments to ensure all services rendered are properly authorized, coded, billed, and reimbursed. This position works closely with providers, clinical staff, and the revenue cycle department to identify missed charges, resolve billing discrepancies, ensure compliance with payer requirements, and maximize reimbursement. The specialist serves as the primary revenue integrity contact for assigned departments such as Radiology, Laboratory, Infusion Services, Audiology, and procedural specialties (e.g., Neurology, Podiatry). The role focuses on identifying revenue leakage, improving billing accuracy, supporting prior authorizations, and improving collections performance.

Requirements

Associate degree in Healthcare Administration, Business Administration, Health Information Management, or related field.
Minimum 3 years experience in medical billing, coding, or revenue cycle management.
Experience working with prior authorizations, insurance claims, and reimbursement processes.
Strong knowledge of medical billing, CPT, HCPCS, and ICD-10 coding concepts
Understanding of payer reimbursement methodologies
Ability to conduct billing audits and identify revenue opportunities
Strong analytical and problem-solving skills
Knowledge of prior authorization requirements
Ability to communicate effectively with providers and clinical staff
Experience working with EHR and billing systems
Detail-oriented with strong organizational skills
Ability to work independently and manage multiple departments simultaneously
Knowledge of healthcare compliance and regulatory standards

Nice To Haves

Bachelor’s degree in Healthcare Administration, Business, or related field.
Certified Professional Coder (CPC) – AAPC
Certified Coding Specialist (CCS)
Certified Revenue Cycle Representative (CRCR)
Experience auditing hospital or multi-specialty clinic billing.
Experience with procedure-based specialties (radiology, neurology, podiatry, infusion services).
Experience identifying and resolving revenue leakage or missed charges.

Responsibilities

Perform regular billing audits for assigned departments to ensure all services rendered are billed accurately and completely.
Identify missed charges, underbilling, or coding errors and coordinate corrections with billing and coding teams.
Review provider documentation to ensure billable services are captured appropriately.
Monitor high-value service lines including but not limited to: Radiology Laboratory Infusion services Audiology Procedural specialties (Neurology, Podiatry, etc.)
Track and resolve revenue leakage, including missed interpretations, procedures, or ancillary services.
Ensure prior authorizations are obtained and documented for applicable services.
Collaborate with providers and clinical staff to ensure proper documentation supports billing requirements.
Assist in denial management and appeals related to assigned departments.
Monitor reimbursement trends and payer requirements to identify opportunities for improved revenue capture.
Work with the revenue cycle leadership to develop department-specific revenue improvement strategies.
Provide education and feedback to clinical departments regarding billing compliance and documentation standards.
Support revenue cycle initiatives focused on maximizing reimbursement and improving collections.
Maintain compliance with Medicare, Medicaid, commercial payer regulations, and HIPAA.