In an environment of continuous quality improvement, the Billing Specialist is responsible for the accurate and compliant processing of medical claims using the Meditech billing platform. This role ensures timely reimbursement by applying appropriate billing practices, revenue codes, and modifiers in accordance with CMS guidelines and payer-specific requirements. The specialist monitors claim status, resolves discrepancies, and collaborates with clinical, coding, and registration teams to support the financial health of the organization.
This position demands a strong understanding of Medicare, Medicaid, and commercial insurance policies, as well as an ongoing commitment to ethical billing, customer service excellence using AIDET principles, and continuous improvement. The Billing Specialist also contributes to compliance and audit readiness through detailed documentation and adherence to internal policies and federal regulations. Exhibits the MHS Standards of Excellence and exercises strict confidentiality at all times.
Job Functions: Follows ethical billing practices. Exhibits exceptional customer service skills, utilizing AIDET. Maintains compliance with patient accounting policies and procedures.
Completes special projects as assigned. Maintains a comprehensive awareness of all insurance company updates including Federal and State guidelines. Prepare, review, and submit accurate and complete claims through the Meditech billing platform, ensuring compliance with federal and payer-specific regulations.
Prepare, review, and submit accurate and complete claims through the Meditech billing platform, ensuring compliance with federal and payer-specific regulations. Apply appropriate revenue codes, encounter-based billing practices, and modifiers according to CMS guidelines. Monitor claim status, follow up on unpaid or denied claims, and take corrective actions to ensure timely reimbursement.
Coordinate with clinical, coding, and registration teams to resolve billing discrepancies or documentation issues. Utilize Meditech tools and reports to track billing productivity, aging accounts, and reimbursement trends. Maintain current knowledge of billing rules and payer requirements, especially for Medicare and Medicaid programs.
Assist in the posting of payments, adjustments, and refunds within Meditech as needed. Respond to internal and external billing inquiries, including those from patients, clinic staff, and insurance carriers. Contribute to compliance efforts and support audits by maintaining thorough documentation and following established policies.
Participate in ongoing system training and process improvement related to Meditech updates and billing changes. Assumes all other duties and responsibilities as necessary. Qualifications Minimum Education/Experience Required: High School Diploma or GED required.
Minimum of 2 years of experience in hospital, medical office or clinic setting in healthcare required. Minimum of 1 year of experience with billing preferred. Certification such as Certified Professional Biller (CPB), Certified Medical Reimbursement Specialist (CMRS), or Certified Professional Coder (CPC) preferred.
Experience with Medicare and Medicaid claim processes and payer portals and understanding of RHC cost reporting and its connection to billing preferred. Special Knowledge, Skills, Training: Hands-on experience with Meditech billing and revenue cycle modules. Strong knowledge of CMS billing requirements, including encounter-based billing and wrap-around payments, familiarity with both 1500 and UB-04 claim forms.
Excellent problem-solving skills and attention to detail. Ability to work independently and collaboratively in a team environment. Needs good telephone voice and skill in handling business transactions, including irate patients; ability to work with computerized system, also basic clerical and interpersonal skills and typing at 40 wpm.
Ability to read, understand and follow oral and written instructions. Computer skills, including but not limited to Microsoft Word and Excel. Excellent organizational, time management, and customer service skills.
Compensation Details: Education, experience, and tenure may be considered along with internal equity when job offers are extended.
- Memorial Health System is proud to offer an affordable, comprehensive benefit package to all full time and flex time employees. To learn more about the many benefits we offer, please visit our website at www.mhsystem.org/benefits . Bonus Eligibility: Available to qualifying full or flex time employees. Eligibility will be determined upon offer. Memorial Health System is an equal opportunity provider and employer. If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at https://www.ocio.usda.gov/document/ad
- 3027 , or at any USDA office, or call (866) 632
- 9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W., Stop 9410, Washington, D.C. 20250
- 9410, by fax (202) 690
- 7442 or email at program.intake@usda.gov . * Memorial Health System is a federal drug-free workplace. This policy prohibits marijuana use by employees.
8-Hour Day Shift