Medical Billing Representative

Job description

Job Title: Medical Billing Rep Department: Revenue Cycle Location: Massena Hospital Hours Per Week: 40 Schedule: 8a-4p (Mon-Fri) SUMMARY: A Medical Billing and Denials Specialist is responsible for managing the billing process, submitting claims to insurance companies, following up on unpaid or denied claims, and ensuring timely reimbursement for healthcare services. This role plays a critical part in the revenue cycle management of the healthcare organization by identifying trends in denials and taking corrective actions. RESPONSIBILITIES: Medical Billing Expertise : Proficient in billing, claims processing (Inpatient, Outpatient, Critical Access, Rural Health), denials management, and knowledge of medical terminology, physician fee schedules, DRGs, and reimbursement procedures. Claims and Appeals Processing : Submits and follows up on insurance claims; resolves denials and rejections; prepares appeal letters with proper documentation and cross-department coordination. Account Management & Collections : Retrieves and updates patient account statuses, processes remittances, manages A/R, ensures accurate charge entry, and performs financial analysis to support revenue goals. Communi...