Billing and posting representative

Job description

The Billing and posting representative is responsible for accurate and timely billing of hospital and Rural Health Clinic (RHC) claims to insurance payers. This role focuses heavily on denial management, claim follow-up, and reimbursement optimization while ensuring compliance with payer contracts, federal regulations, and internal policies. Key Responsibilities: Billing & Claims Submission: - Prepare, review, and submit hospital and RHC claims to commercial insurance carriers. - Ensure correct use of CPT, HCPCS, ICD-10, revenue codes, modifiers, and RHC-specific billing requirements. - Verify charges, units, dates of service, provider credentials, and place of service. - Submit corrected, adjusted, and late charges as needed. Denial Management: - Analyze and resolve billing denials, rejections, and underpayments. - Identify root causes of denials (coding, authorization, eligibility, medical necessity, bundling, timely filing, etc.). - Prepare and submit corrected claims and formal appeals with appropriate documentation. - Track denial trends and recommend process improvements to reduce future denials. Insurance Follow-Up: - Conduct timely follow-up with payers on unpaid, underpaid...