Role Description As a Remote Billing Specialist at Community Health Systems (CHS) - Shared Services Center, you’ll play a vital role in quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. The Remote Medical Billing Specialist is responsible for processing, auditing, and submitting primary and secondary insurance claims, ensuring accuracy, compliance, and timely reimbursement. This role utilizes electronic claims management systems to review, correct, and resolve billing errors, denials, and rejections. The Billing Specialist I collaborates with internal teams, facility liaisons, and payers to ensure clean claim submission and adherence to federal, state, and payer-specific regulations. - Processes and submits primary and secondary insurance claims accurately and in a timely manner, ensuring compliance with payer guidelines and regulatory requirements. - Reviews and resolves claim errors, rejections, and denials, making necessary corrections and resubmitting claims as needed. - Demonstrates working knowledge of billing forms, including UB-04, CMS-1500, or state-specific billing forms, ensuring claims are submitted with the appropriate documentation. - Audits claims for accuracy, checking for duplicate charges, overlapped accounts, and missing information before submission. - Investigates and processes rebill requests, verifying claim accuracy and making necessary updates per facility or coding liaison direction. - Maintains knowledge of billing regulations, payer policies, and electronic submission guidelines, staying up to date with federal, state, and local billing requirements. - Utilizes electronic billing systems to analyze, research, and transmit claims, ensuring proper documentation of actions taken in the collection system. - Monitors and reports charging or edit trends, collaborating with internal teams (such as coding, patient access, and ancillary departments) to improve billing accuracy. - Performs daily balancing tasks using SSI and other billing systems, escalating unresolved issues or billing delays to the Billing Services Manager. - Communicates professionally with payers, facility representatives, and internal teams, ensuring efficient issue resolution and proper follow-up on outstanding claims. - Performs other duties as assigned. - Complies with all policies and standards. Qualifications - H.S. Diploma or GED required - Associate Degree in Business, Healthcare Administration, Medical Billing, or a related field preferred - 0-1 years of experience in medical billing, insurance claims processing, or revenue cycle operations required - 1-3 years of billing experience in a medical facility, ambulatory surgery facility, or acute-care preferred - Experience with hospital or physician billing, including knowledge of payer policies and electronic claims systems preferred Requirements - Basic understanding of insurance claim processing, medical billing, and reimbursement guidelines. - Familiarity with billing software, electronic claims management systems (e.g., SSI, Pulse/DAR), and eligibility tools. - Knowledge of CMS, Medicaid, Medicare, and commercial insurance billing regulations. - Ability to analyze and resolve claim errors, denials, and rejections efficiently. - Strong attention to detail, organizational skills, and ability to meet deadlines. - Proficiency in Microsoft Office Suite (Excel, Outlook, Word) and electronic health record (EHR) systems. - Excellent communication and problem-solving skills, with the ability to interact professionally with internal teams and external payers. Benefits - Paid Time Off (PTO) - Comprehensive Health Benefits - Medical, Dental & Vision - 401k with company match - Tuition reimbursement Company Description Community Health Systems is one of the nation's leading healthcare providers. With healthcare delivery systems in 36 distinct markets across 14 states, CHS operates 69 affiliated hospitals with more than 10,000 beds and approximately 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, imaging centers, cancer centers, and ambulatory surgery centers. This position is not eligible for immigration sponsorship now or in the future. Applicants must be authorized to work in the U.S. for any employer.

• Ability to comprehend medical record documentation to accurately assign codes for both concurrent and discharged accounts across multiple specialties. • Meets minimum requirements for production and quality monthly. • Requires a working knowledge of code sequencing for grouper-related payers with attention to detail to avoid rework and waste with charge capture assessment component. • Requires understanding and application of M.E.A.T. criteria (i.e., monitoring, evaluation, assessment, treatment) using ICD 10 CM transaction data set to capture diagnoses. • Analyzes high-risk encounters for accurate and/or missing charges gaps prior to encounter completion (i.e., missing charges from anesthesia, surgery) when manual charge capture occurs. • Understand complexity of billing requirements and incorporates payer specific trends into day-to-day reviews to reduce “take backs” associated with un-clear, or un-substantiated care rendered. (i.e., varying modifier assignment for EAPG vs. Non-EAPG payer specificity) • Requires excellent coding knowledge of ICD 10 CM, CPT 4, and modifier application, with expectations to maintain certification (i.e., CCS, CPC, RHIT, or RHIA) and apply ICD 10 CM Coding Guidelines specific to both inpatient and outpatient encounters. • Facilitate modifications to clinical documentation through query interaction to ensure that the information captured supports the level of service rendered, with attention towards chronic conditions, hierarchical condition categories (HCC), and risk adjustment factors (RAF). • Demonstrates an excellent working knowledge of hospital information systems to retrieve data specific information (i.e., order diagnosis, patient type) within a complicated filing schema including non-hospital data (i.e., Media Tab, Office Visits etc)

• Performs all assigned billing in a timely manner • Communicates with the physician the documentation needed to complete job functions • Ensures accurate coding from the medical record regarding ICD-9 and ICD-10, appropriate evaluation and management CPT code • Updates patient record with patient’s current insurance, address and telephone numbers • Identifies primary care doctor and referral source with contact information and documents it in the medical record • Performs claims follow up and reviews with billing agent in a timely manner • Protects patient confidentiality according to HIPAA guidelines • Maintains proper credentials and researches coding issues to ensure correct coding initiative per CMS guidelines • Identifies and attends one course/conference per specialty, per year to continue education in the coding field • Must have Ortho billing experience

• Perform coding and related duties using established billing office policies in an accurate and timely manner. • Primary contact with physicians, department administrators, hospital and/or clinical department administrators and their support staff and billing staff. • Coordinates professional service billings for selected clinical departments. • Assignment or verification of CPT, ICD-10 CM coding and modifiers based upon documentation. • Resolve edits for electronic charges, following established policies and procedures to ensure that all data elements (claim requirements – CPT, ICD-10 CM, modifiers, provider, billing area, etc.) are applied. • Monitor charge flow and act as a liaison with managers, department administrators and other billing personnel to assure consistent and accurate change flow. • Identify, report, and resolve coding and reimbursement issues. • Develop and maintain all protocols related to their assigned areas. • Maintain understanding all Teaching Physician and provider documentation policies. • Actively participate in new provider orientations.