Inpatient Medical Biller

Inpatient Medical Biller

Nexus Health Systems is seeking an experienced Inpatient Medical Biller to join our Central Business Office. This role is responsible for the accurate and timely billing of inpatient hospital claims to government and commercial payers. We are looking for a highly detail-oriented professional with experience in hospital billing, electronic claim submission, and navigating payer-specific billing requirements.

This is a medical billing positionnot a collections role. The ideal candidate has hands-on experience submitting claims through a clearinghouse, understands hospital billing codes and claim requirements, and has successfully billed both in-state and out-of-state payers.

Essential Responsibilities

• Prepare, review, and submit accurate inpatient hospital claims for Medicare, Medicaid, managed care, and commercial insurance payers.
• Submit claims electronically through a clearinghouse and monitor claim acceptance, edits, and rejections.
• Review patient accounts and billing documentation to ensure claims are complete, accurate, and compliant prior to submission.
• Verify all required documentation is present to support timely reimbursement.
• Research and resolve claim edits and rejections to ensure clean claim submission.
• Coordinate corrected claims and rebills as needed.
• Monitor electronic claim status to confirm payer receipt and acceptance.
• Utilize medical billing codes and payer-specific guidelines to ensure billing accuracy.
• Bill claims for both in-state and out-of-state payers while adhering to payer-specific requirements.
• Maintain accurate documentation within patient accounts and billing systems.
• Collaborate with facility staff and internal departments to obtain supporting documentation for claim submission.
• Identify billing trends or process issues that could impact reimbursement and recommend improvements.
• Maintain compliance with all federal, state, and payer billing regulations.
• Assist with additional revenue cycle responsibilities as assigned.

Qualifications

Required

• High school diploma or equivalent.
• Minimum of one (1) year of inpatient hospital medical billing experience.
• Experience submitting claims through an electronic clearinghouse.
• Knowledge of hospital billing processes and revenue cycle operations.
• Strong understanding of medical billing codes, payer requirements, and claim submission guidelines.
• Experience billing Medicare, Medicaid, managed care, commercial insurance, and out-of-state payers.
• Exceptional attention to detail and organizational skills.
• Strong communication and problem-solving abilities.
• Proficiency with electronic medical records and billing software.

Preferred

• Associate degree or college coursework in Healthcare Administration, Business, or a related field.
• Experience with UB-04 claims, electronic remittance advice (ERA), and EDI transactions.
• Experience billing for inpatient rehabilitation, behavioral health, long-term acute care, or specialty hospitals.
• Knowledge of denial prevention and clean claim best practices.

Why Join Nexus Health Systems?

At Nexus Health Systems, our Central Business Office plays a critical role in supporting exceptional patient care by ensuring accurate and timely reimbursement. As an Inpatient Medical Biller, you'll join a collaborative team committed to operational excellence, compliance, and continuous improvement while supporting hospitals that provide specialized care to patients with complex medical and behavioral needs.