Billing Specialist

Cheyenne Regional Medical Center • Cheyenne, WY

3d

About The Position

The Billing Specialist is responsible for the timeliness and accuracy of patient account billing and payer reimbursement. The role ensures accurate coordination of benefits and appropriate reimbursement in accordance with organizational payer contracts. It also provides outstanding customer service to patients, customers, and payer sources.

The specialist reviews assigned Epic Work Queues, researches coverage and claims, evaluates payer remittance advice and explanations of benefits, and pursues appeals to resolve denials. The role requires staying current on payer and healthcare industry changes and maintaining knowledge of Medicare, Medicaid, commercial insurance programs, filing deadlines, billing requirements, and reimbursement methods. Performance focuses on reducing Accounts Receivable Days and denial rates, while supporting process improvement and quality assurance.

Requirements

• High school diploma or an equivalent certificate from an accredited program, or a higher degree.
• At least six months of customer service and/or monetary transaction experience.
• Knowledge and understanding of federal and state billing and coding regulations and compliance.
• Knowledge and understanding of HIPAA.
• Ability to multitask with a high attention to detail.
• Ability to type at least 40 words per minute.
• Ability to handle cash.
• Knowledge of medical terminology and coding.

Nice To Haves

• Completion of a billing/coding program with certification.
• Healthcare and/or insurance billing experience.
• Home care billing experience.

Responsibilities

• Pursue and participate in education related to assigned payers to stay current with healthcare industry changes, including through payer websites, newsletters, webinars, and assigned payer meetings.
• Review accounts daily in assigned Epic Work Queues and prioritize them by dollar amount and timely filing rules to achieve the best possible reimbursement.
• Research and submit claims to the appropriate payer based on coordination of benefits and active coverage when services were rendered.
• Evaluate payer remittance advice and explanations of benefits for denial accuracy according to individual payer contracts.
• Maintain knowledge of Medicare, Medicaid, commercial insurance programs, Medicare HMOs, and state programs, including filing deadlines, billing requirements, and reimbursement methods.
• Compose and submit appeals to third-party payers, escalating appeals to the highest level to resolve account denials and obtain proper reimbursement.
• Receive and research inquiries from patients, payers, attorneys, and third parties through calls and correspondence; review available remits, contracts, documentation, policies, procedures, and insurance laws to provide informative responses and direct accounts appropriately.
• Meet or exceed performance metrics for the assigned role, focusing on reducing Accounts Receivable Days and denial rates.
• Provide management with feedback on denial trends and claim edits to support process improvement and billing software quality assurance.
• Provide exemplary customer service and communicate positively, courteously, accurately, and honestly.

Benefits

• Employer-sponsored medical, dental, and vision plans.
• 403(b) and 457(b) retirement options with a 4% employer match.
• Life insurance.
• Short-term and long-term disability insurance.
• Employer-sponsored wellness program.
• Employee Assistance Program.
• 21 PTO days per year, increasing with tenure.
• Tuition reimbursement program.
• Dedicated loan forgiveness advisory service.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED