PFS Biller-8115
About The Position
All KHI employees are expected to perform their respective tasks and duties in such a way that supports KHI’s vision to be among the kindest, highest quality health systems in the country. The purpose of this position is to ensure the accurate and timely billing of hospital services to insurance carriers, government programs, and patients in compliance with all regulatory and contractual requirements. The Hospital Insurance Billing Specialist plays a key role in the hospital’s revenue cycle by reviewing patient accounts, verifying insurance coverage, preparing and submitting claims, and resolving billing discrepancies to maximize reimbursement and minimize delays. This position supports the hospital’s financial integrity and commitment to high-quality patient care by maintaining exceptional attention to detail, adhering to compliance standards, and providing excellent communication and customer service to patients, payers, and internal departments.
Requirements
- High school graduate or equivalent
- Six months or more of progressive work experience
- Ability to communicate effectively with others
- Ability to manage multiple priorities and tasks
- Ability to maintain attention to detail
- Knowledge of and ability to use computer hardware and software applications
Nice To Haves
- One year hospital or clinic billing experience preferred.
Responsibilities
- Reviews CMS-1500 and UB-04 claim forms for completeness, efficiency, and accuracy prior to submission.
- Reviews claims for reasonableness of charges and obtains supporting medical documentation when necessary.
- Bills secondary insurance as appropriate and ensures proper coordination of benefits.
- Works rejection reports to correct and re-bill claims accurately and promptly.
- Periodically reviews training materials to ensure adherence to updated billing procedures and compliance standards.
- Meets established accuracy metrics as communicated; metrics may vary based on biller level.
- Understands payer contracts and guidelines to ensure timely follow-up and prevent untimely denials or delays in cash flow.
- Maintains effective communication within business and clinical divisions to resolve billing and documentation issues.
- Responds professionally and promptly to inquiries received via telephone, email, or task management systems.
- Actively participates in departmental meetings, performance improvement initiatives, and committees as assigned.
- Identifies and communicates inaccuracies or unclear information in training materials to promote process integrity.
- Utilizes the Issues Log or other established channels to report and track billing-related concerns.
- Meets or exceeds departmental productivity standards for daily billing volume, report management, and rejection resolution.
- Submits all claims electronically whenever possible to meet the departmental goal of at least 80% electronic submissions.
- Maintains consistent performance in line with established productivity expectations.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
