Community Memorial Hospital, Hamilton
Overview
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RHC Billing Specialist
role at
Community Memorial Hospital, Hamilton . Responsibilities
Manage RHC billing processes, including timely and accurate clean claim submission to all payers. Monitor, track, and reconcile accounts receivable to ensure payments are received, posted, and discrepancies resolved. Oversee payer contract management, including review of current agreements, identifying reimbursement opportunities, and supporting or leading payer negotiations. Ensure compliance with all federal and state reimbursement regulations governing RHCs. Regularly review coding and documentation for accuracy and compliance with RHC-specific requirements. Identify, track, and address denials or underpayments; implement corrective action plans to prevent recurrence. Collaborate with the Director of Revenue Cycle and other hospital leadership to optimize billing practices and maintain regulatory compliance. Prepare and analyze reports to monitor reimbursement trends, denials, and payer performance. Serve as a subject matter expert on RHC billing, coding, and reimbursement for staff education and provider support. Assist with internal and external audits related to RHC billing and reimbursement. Maintain payer communication and support expansion of payer networks when financially advantageous. Ensure that hospital revenue cycle processes maximize RHC designation benefits. Other duties as assigned by Supervisor. Qualifications
Associate’s degree in healthcare administration, accounting, or related field (preferred). Minimum of 5 years of billing experience, with specific experience in RHC or FQHC settings preferred. Strong knowledge of medical terminology and healthcare reimbursement processes. Demonstrated understanding of RHC-specific billing and cost-based reimbursement requirements. Ability to analyze payer contracts and identify opportunities for improved reimbursement. Proficient in MS Office, electronic claims submissions, and electronic medical record (EMR) systems. Ability to communicate professionally with providers, payers, and internal staff. Strong organizational skills and ability to handle multiple tasks simultaneously. Strong interpersonal, written, and verbal communication skills. Ability to work autonomously, exercise discretion, and maintain confidentiality. High attention to detail and accuracy in billing and compliance activities. Employment Type
Full-time Seniority level
Mid-Senior level Note: This description removes boilerplate and unrelated postings while preserving the core responsibilities and requirements for the role.
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Join to apply for the
RHC Billing Specialist
role at
Community Memorial Hospital, Hamilton . Responsibilities
Manage RHC billing processes, including timely and accurate clean claim submission to all payers. Monitor, track, and reconcile accounts receivable to ensure payments are received, posted, and discrepancies resolved. Oversee payer contract management, including review of current agreements, identifying reimbursement opportunities, and supporting or leading payer negotiations. Ensure compliance with all federal and state reimbursement regulations governing RHCs. Regularly review coding and documentation for accuracy and compliance with RHC-specific requirements. Identify, track, and address denials or underpayments; implement corrective action plans to prevent recurrence. Collaborate with the Director of Revenue Cycle and other hospital leadership to optimize billing practices and maintain regulatory compliance. Prepare and analyze reports to monitor reimbursement trends, denials, and payer performance. Serve as a subject matter expert on RHC billing, coding, and reimbursement for staff education and provider support. Assist with internal and external audits related to RHC billing and reimbursement. Maintain payer communication and support expansion of payer networks when financially advantageous. Ensure that hospital revenue cycle processes maximize RHC designation benefits. Other duties as assigned by Supervisor. Qualifications
Associate’s degree in healthcare administration, accounting, or related field (preferred). Minimum of 5 years of billing experience, with specific experience in RHC or FQHC settings preferred. Strong knowledge of medical terminology and healthcare reimbursement processes. Demonstrated understanding of RHC-specific billing and cost-based reimbursement requirements. Ability to analyze payer contracts and identify opportunities for improved reimbursement. Proficient in MS Office, electronic claims submissions, and electronic medical record (EMR) systems. Ability to communicate professionally with providers, payers, and internal staff. Strong organizational skills and ability to handle multiple tasks simultaneously. Strong interpersonal, written, and verbal communication skills. Ability to work autonomously, exercise discretion, and maintain confidentiality. High attention to detail and accuracy in billing and compliance activities. Employment Type
Full-time Seniority level
Mid-Senior level Note: This description removes boilerplate and unrelated postings while preserving the core responsibilities and requirements for the role.
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