Billing Office Specialist

Job Description

Job Description

Description:

Position Summary: The Billing Office Specialist performs assigned billing office functions for Kane County Hospital and its clinic operations, including claim review, claim submission, billing edits, payer follow-up, payment posting support, accounts receivable work queues, denial follow-up, patient account documentation, refund and credit balance support, bad debt preparation support, and revenue cycle reporting support. This position protects cash flow by completing assigned work accurately, timely, and consistently with payer requirements, hospital policy, and compliance standards.

Purpose

The purpose of this position is to protect the financial integrity, compliance posture, patient experience, and cash flow of the organization by ensuring assigned billing, claim, payment, denial, refund, credit balance, and accounts receivable functions are completed accurately, timely, legally, and consistently with industry standards.

The Billing Office Specialist is responsible for assigned hospital, emergency department, outpatient, ancillary, surgical, ambulance, and clinic billing office work. The position performs work that directly affects billing accuracy, claim timeliness, collections, denial recovery, accounts receivable aging, refund accuracy, credit balance resolution, compliance, reporting, and patient financial communication.

1. Review assigned accounts for complete registration, insurance, guarantor, subscriber, accident, workers compensation, Medicare Secondary Payer, consent, notice, and financial information before claim submission or account follow-up.

2. Resolve claim edits, billing errors, payer rejections, missing information, and account holds within assigned timelines.

3. Submit clean, accurate, timely claims for institutional, professional, clinic, emergency department, outpatient, surgical, ancillary, Medicare, Medicaid, commercial, managed care, workers compensation, and self-pay accounts.

4. Work assigned accounts receivable queues by payer, aging category, account type, denial status, authorization status, and dollar priority.

5. Research, appeal, correct, and document denials, underpayments, recoupments, payer takebacks, and claim follow-up activity.

6. Post, review, or support payment posting, contractual adjustments, remittance activity, unapplied cash, refund requests, and credit balance resolution as assigned.

7. Support patient billing, statements, payment plans, collection documentation, charity care routing, financial assistance routing, and bad debt preparation according to policy.

8. Maintain account notes, payer communication records, denial documentation, appeal evidence, refund support, and audit files in a complete and timely manner.

9. Identify recurring billing errors, payer delays, authorization-related denials, registration issues, coding delays, and system problems and escalate them immediately.

10. Support revenue cycle reporting, including accounts receivable aging, denial trends, claim lag, collections, credit balances, bad debt, and productivity.

11. Follow written procedures, payer-specific job aids, checklists, audit requirements, and corrective action instructions.

12. Perform other related duties as assigned by the Business Office Manager or Chief Financial Officer.

1. Strong working knowledge of hospital and clinic revenue cycle operations, including registration, eligibility, authorizations, coding interfaces, billing, collections, denials, refunds, and credit balances.
2. Ability to read, interpret, and operationalize payer rules, authorization requirements, remittance advice, explanation of benefits, payer contracts, and billing edits.
3. Knowledge of Medicare, Medicaid, commercial payer, managed care, workers compensation, self-pay, and patient financial assistance workflows.
4. Ability to supervise staff, enforce deadlines, measure productivity, correct errors, and document accountability.
5. Strong analytical skills, including the ability to interpret accounts receivable aging, denial reports, cash reports, credit balance reports, authorization reports, and productivity reports.
6. Ability to communicate clearly with patients, staff, payers, clinical departments, vendors, auditors, and leadership.
7. Commitment to confidentiality, accuracy, compliance, audit readiness, and professional patient financial communication.
8. Ability to work independently within Oracle (Cerner) and SSI.

Principal Accountabilities

1. Business Office work queues are current, assigned, monitored, and completed within approved timelines.
2. Registration, eligibility, authorization, billing, denial, collection, refund, credit balance, and bad debt processes are accurate, timely, documented, and compliant.
3. Preventable denials, missed authorizations, avoidable late charges, missing information, claim rejections, and payer underpayments are identified, corrected, and reported.
4. Staff receive training, job aids, feedback, and accountability necessary to meet required performance standards.
5. Patients receive clear, respectful, compliant communication regarding financial responsibility, financial assistance, billing questions, and collection activity.
6. Revenue cycle data is reported accurately and used to drive corrective action.
7. Compliance concerns are escalated immediately and documented according to policy.
8. Leadership receives timely notice of material revenue leakage, payer noncompliance, system issues, staffing barriers, or unresolved operational failures.

Required Key Performance Indicators and Industry Standards

The Business Office Manager must manage performance using recognized revenue cycle key performance indicators, including HFMA MAP Key categories for patient access, pre-billing, claims, account resolution, and financial management. Targets must be reviewed at least monthly, trended over time, and adjusted when payer mix, service line changes, system limitations, or leadership-approved benchmarks require a different operating standard.