Inpatient Billing and Collections Specialist

Nexus Health Systems Ltd•Houston, TX

About The Position

The Inpatient Billing & Collections Specialist serves as a key member of the Central Business Office team and is responsible for managing inpatient accounts receivable, billing follow-up, collections, denial resolution, and reimbursement activities for aged accounts. This position ensures claims are billed accurately and timely, account documentation supports reimbursement expectations, and all collection activities are completed in accordance with payer contracts, Federal and State regulations, and company policies. The ideal candidate will have strong knowledge of hospital billing procedures, insurance follow-up, and revenue cycle operations with the ability to manage a high-volume workload while maintaining attention to detail and professionalism.

Requirements

High school diploma or equivalent required
Minimum of one (1) year of experience in a hospital business office, healthcare billing, or medical collections environment required
Strong understanding of medical billing and collections processes
Knowledge of insurance claims, denials, appeals, and reimbursement guidelines
Excellent organizational and time management skills
Ability to manage a high-volume workload and meet productivity expectations
Strong written and verbal communication skills
Detail-oriented with strong analytical and problem-solving abilities
Proficiency with electronic medical records and billing systems
Ability to work independently and collaboratively in a team environment

Nice To Haves

Associate degree or additional college coursework preferred
Experience with inpatient billing and insurance follow-up preferred
Knowledge of Medicare, Medicaid, Managed Care, and commercial insurance reimbursement practices preferred

Responsibilities

Respond to incoming telephone calls and correspondence related to patient accounts and route inquiries appropriately.
Review admission and billing documentation to confirm claims are accurate and supported according to payer contract guidelines.
Communicate with insurance companies, facilities, and internal departments to obtain additional information necessary for claim resolution and timely reimbursement.
Verify claims have been billed, received, and processed appropriately by payers.
Maintain organized and complete patient financial files, including claims, EOBs, appeals, and correspondence.
Research and resolve denied, rejected, or unpaid claims by coordinating rebills and obtaining required payer information.
Follow up on unpaid claims beyond contractual payment timelines to maximize reimbursement.
Monitor electronic claim submissions to ensure claims are accepted without rejection.
Work assigned aging accounts daily while documenting all collection efforts and account activity thoroughly.
Post payments, adjustments, and patient responsibility balances accurately and timely.
Process adjustments and account corrections within established departmental timelines.
Prepare account summaries and updates for aged accounts and monthly Accounts Receivable review meetings.
Coordinate with facility personnel to obtain documentation needed for appeals and payment resolution.
Identify and escalate reimbursement concerns, payer trends, or process issues that may impact collections.
Identify and process credit balances and refund requests in accordance with Federal, State, and payer requirements.
Assist with audit preparation and maintenance of complete patient account records.
Support additional Central Business Office functions and team initiatives as assigned.