Inpatient Billing Specialist

Job Summary

The Inpatient Billing Specialist is responsible for accurate and timely billing of inpatient hospital services. This role ensures compliance with payer requirements, hospital policies, and federal and state regulations while maximizing reimbursement and minimizing denials.

Key Responsibilities

• Review inpatient medical records to ensure complete and accurate charge capture

• Prepare, review, and submit inpatient claims to Medicare, Medicaid, and commercial payers

• Assign and validate appropriate diagnosis and procedure codes (ICD-10-CM/PCS, DRG/APR-DRG)

• Ensure compliance with payer billing guidelines, CMS regulations, and hospital policies

• Monitor claim status and follow up on unpaid, underpaid, or denied claims

• Research and resolve billing discrepancies, edits, and claim rejections

• Work closely with coding, utilization review, case management, and clinical staff to resolve issues

• Process corrections, adjustments, and rebills as needed

• Maintain detailed documentation of billing activities and payer communications

• Meet productivity and accuracy standards while adhering to billing timelines

Required Qualifications

• High school diploma or equivalent (Associate’s degree preferred)

• 2+ years of inpatient hospital billing experience

• Strong knowledge of inpatient billing regulations and payer requirements

• Proficiency in ICD-10-CM/PCS and DRG methodologies

• Experience with hospital billing systems and electronic health records (EHR)

• Strong attention to detail and analytical skills

• Ability to work independently and manage multiple priorities

Preferred Qualifications

• Certification such as CPB, CPC, CCS, or RHIT/RHIA

• Experience with Medicare inpatient billing and audits

• Familiarity with denial management and appeals

• Knowledge of UB-04 claim forms and electronic claim submission

Skills & Competencies

• Excellent organizational and time-management skills

• Strong written and verbal communication abilities

• Problem-solving and critical-thinking skills

• Ability to interpret medical documentation and billing regulations

• Proficiency in Microsoft Office and billing software