Billing and Posting Representative

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, or delayed claims.
• Communicate with insurance representatives to obtain claim status and resolution.
• Maintain detailed notes and documentation in the billing system for all follow-up activity.
• Meet productivity and follow-up benchmarks to ensure timely reimbursement.

Compliance & Collaboration

• Ensure compliance with payer guidelines, hospital policies, and RHC billing regulations.
• Work closely with coding, registration, authorization, and clinical staff to resolve billing issues.
• Stay current on payer policy updates and RHC billing changes.

Required Skills & Qualifications

• Knowledge of hospital and RHC billing processes.
• Strong experience with insurance billing and denial resolution.
• Proficiency in CPT, ICD-10-CM, HCPCS, and modifiers.
• Familiarity with payer portals and claim management systems.
• Strong analytical, organizational, and follow-up skills.
• Ability to manage high-volume workloads with attention to detail.