Department: Business Office
Hours: Fulltime (1.0 FTE) – M-F 7:00 a.m. to 3:30 p.m. with 30-minute meal period

POSITION OVERVIEW:

The Claims Billing Specialist for Floyd County Medical Center is responsible for managing the billing and claims process. This role ensures accurate submission of medical claims to insurance companies, government programs, and patients, while adhering to all regulatory and payer-specific guidelines, including Medicare and Medicaid. The specialist will handle billing for both facility and professional services, claims processing, and follow-up on denied or underpaid claims.

Essential Duties and Responsibilities:

• Claims Submission & Processing
• Prepare and submit accurate claims for inpatient, outpatient, and professional services with Critical Access Hospital and Rural Health Clinic billing guidelines.
• Ensure timely submission of claims to private insurance, Medicare, Medicaid, and other third-party payers.
• Verify accuracy and completeness of patient demographic and insurance information before claims submission.
• Coding & Compliance
• Collaborate with coding specialists to ensure that diagnosis and procedure codes are accurate and appropriate for CAH and RHC services
• Maintain compliance with all federal, state, and local regulations regarding CAH and RHC billing, including adherence to Medicare/Medicaid cost reporting requirements.
• Stay current with changes in billing codes (e.g., CPT, HCPCS, ICD-10) and payer policies.
• Denial Management & Follow-Up
• Investigate and resolve claim denials, rejections, or discrepancies
• Communicate with insurance providers and government payers to appeal underpaid or denied claims
• Conduct regular follow-ups on outstanding claims to expedite payment
• Patient Billing & Customer Service
• Manage patient billing inquiries related to CAH and RHC services.
• Assist patients with understanding their insurance benefits, out-of-pocket costs, and financial assistance options.
• Coordinate with the financial counseling department to ensure patients receive proper financial guidance.
• Team Collaboration
• Work closely with clinical staff, coding teams, and financial departments to ensure the billing process is streamlined and compliant.
• Participate in billing department meetings and ongoing training to stay informed of changes in CAH and RHC reimbursement policies.
• Assists in inventory and ordering of supplies and equipment.
• Assists in maintenance of safe, clean work environment.
• Assists with the general operation of the Patient Financial Services Department.

• Assumes other duties and responsibilities that are related and appropriate to the position and area. The above responsibilities are a general description of the level and nature of the work assigned to this classification and are not to be considered as all-inclusive.

  Minimum Education and/or Experience Required:

• High school diploma or GED required; associate’s or bachelor’s degree in healthcare administration, business or related field preferred.

• Minimum 2 years experience in medical billing, with specific experience in Critical Access Hospital and/or Rural Health Clinic settings preferred.
• Familiarity with Medicare and Medicaid billing and cost reporting requirements for CAH and RHC.
• Proficiency with medical billing software (e.g., Meditech or other electronic health record (EHR) systems).

• Knowledge of coding systems (CPT, HCPCS, ICD-10) and payer-specific guidelines.

  Additional Qualifications:

• Basic computer skills.

• Excellent oral and written communication skills required.
• Ability to communicate with confidence in a group setting.
• Self-motivated.
• Must be able to read, write, comprehend, and verbally communicate in English fluently.
• Integrity and ability to work independently. Initiative to take on tasks without being told.
• Strong attention to detail.
• Adaptive to change, embraces change with optimism.
• Ability to problem solve, critically think.
• Ability to prioritize assignments and manage time efficiently.
• Ability to operate technologies and equipment associated with this position.
• Must have a service mindset and a commitment to continuous learning.
• Ability to work outside of regularly scheduled hours if needed.
• Mandatory Reporter.

PHYSICAL/COGNITIVE REQUIREMENTS:

• Sit: Constant
• Stand: Occasionally
• Walk: Occasionally
• Lift:
• 10 pounds Occasionally
• 25 pounds: Occasionally
• 50 pounds*: Never
• 75 pounds*: Never
• Greater than 100 pounds*: Never
• Carry:
• 10 pounds: Occasionally
• 25 pounds: Occasionally
• 50 pounds*: Never
• 75 pounds*: Never
• Greater than 100 pounds*: Never
• Push/Pull:
• 10 pounds: Occasionally
• 25 pounds: Occasionally
• 50 pounds*: Never
• 75 pounds*: Never
• Greater than 100 pounds*: Never
• Squat/Kneel/Crouch: Occasionally
• Climb: Never
• Balance: Never
• Twist: Frequent
• Bend/Stoop: Occasionally
• Crawl: Never
• Grasp/Grip: Frequent
• Talk: Constant
• Hear: Constant
• See: Constant
• Anything greater than 50 pounds- assist of two or more, or mechanical lift are required.

• Claims Submission & Processing
• Prepare and submit accurate claims for inpatient, outpatient, and professional services with Critical Access Hospital and Rural Health Clinic billing guidelines.
• Ensure timely submission of claims to private insurance, Medicare, Medicaid, and other third-party payers.
• Verify accuracy and completeness of patient demographic and insurance information before claims submission.
• Coding & Compliance
• Collaborate with coding specialists to ensure that diagnosis and procedure codes are accurate and appropriate for CAH and RHC services
• Maintain compliance with all federal, state, and local regulations regarding CAH and RHC billing, including adherence to Medicare/Medicaid cost reporting requirements.
• Stay current with changes in billing codes (e.g., CPT, HCPCS, ICD-10) and payer policies.
• Denial Management & Follow-Up
• Investigate and resolve claim denials, rejections, or discrepancies
• Communicate with insurance providers and government payers to appeal underpaid or denied claims
• Conduct regular follow-ups on outstanding claims to expedite payment
• Patient Billing & Customer Service
• Manage patient billing inquiries related to CAH and RHC services.
• Assist patients with understanding their insurance benefits, out-of-pocket costs, and financial assistance options.
• Coordinate with the financial counseling department to ensure patients receive proper financial guidance.
• Team Collaboration
• Work closely with clinical staff, coding teams, and financial departments to ensure the billing process is streamlined and compliant.
• Participate in billing department meetings and ongoing training to stay informed of changes in CAH and RHC reimbursement policies.
• Assists in inventory and ordering of supplies and equipment.
• Assists in maintenance of safe, clean work environment.
• Assists with the general operation of the Patient Financial Services Department.
• Assumes other duties and responsibilities that are related and appropriate to the position and area. The above responsibilities are a general description of the level and nature of the work assigned to this classification and are not to be considered as all-inclusive