Position Summary

We are seeking a knowledgeable and detail-oriented Revenue Cycle Billing Specialist with facility billing experience to join our team.  This role requires expertise in inpatient and outpatient billing, device billing, and charge description master (CDM) management to ensure accurate and timely claim submission and reimbursement.

The ideal candidate will have a strong understanding of the revenue cycle, payer requirements, and claim workflows, and will work collaboratively across departments to identify and resolve billing issues that impact revenue.

Primary Duties

• Facility Billing: Execute and oversee billing processes for both inpatient and outpatient services in accordance with payer guidelines and organizational policies.
• Device Billing: Ensure proper billing of implants and high-cost medical devices, including verifying documentation, HCPCS coding, and revenue code alignment.
• CDM Management: Maintain and update the Charge Description Master (CDM), ensuring alignment with current CPT/HCPCS codes, pricing strategy, and regulatory requirements.
• Claim Edits & Denial Management:
• Review and resolve pre-bill claim edits to ensure clean claim submission.
• Collaborate with coding and clinical teams to correct claims and minimize denials.
• Regulatory Compliance: Maintain knowledge of CMS guidelines, local coverage determinations (LCDs), national coverage determinations (NCDs), and payer-specific policies.
• Charge Capture Audits: Work with clinical departments to ensure accurate and complete charge capture, especially for surgical procedures, diagnostics, and supplies.
• Reimbursement Support: Assist with payer contract interpretation and escalate reimbursement discrepancies.
• System Optimization: Collaborate with IT and EHR teams (e.g., Epic, Oracle) to ensure billing systems are configured properly and support streamlined billing workflows.
• Reporting & Analysis: Provide regular reporting on billing metrics, claim volumes, denial trends, and reimbursement variances.

Qualifications/Specifications

• Education: Bachelors degree in Business Administration, Finance, Accounting or Healthcare Administration.
• Licensure/Certification: None required. Lean Six Sigma certification preferred.
• Experience:
• 3–5+ years of experience in facility billing in a hospital or large health system.
• In-depth knowledge of inpatient and outpatient billing, DRG/APC reimbursement methodologies, UB-04 billing, and claim life cycles.
• Experience with CDM maintenance and understanding of pricing and coding impact on reimbursement.
• Familiarity with EHR and billing systems (e.g., Oracle, Epic, Cerner).
• Strong analytical and problem-solving skills.
• Certification (e.g., CRCR, CPC-H, CHRI) preferred but not required.

Position Summary

We are seeking an experienced and detail-oriented Hospital/Facility Biller with a strong background in pharmacy charge capture, maintenance, and reconciliation. The ideal candidate will possess a deep understanding of inpatient and outpatient billing workflows, pharmacy billing compliance, and charge description master (CDM) processes. Experience with EHR systems such as EPIC, Cerner, or Oracle is essential.

Primary Duties

• Accurately process and review hospital facility claims with a focus on pharmacy-related charges.
• Maintain and update the pharmacy portion of the charge master (CDM) in compliance with billing regulations.
• Validate charge entries against clinical documentation to ensure proper billing of medications and infusions.
• Identify and resolve claim edits, denials, and rejections related to drug charges and coding.
• Work closely with pharmacy, coding, and revenue integrity teams to maintain pricing accuracy and billing compliance.
• · Assist with revenue leakage prevention by auditing charge capture processes.
• Navigate and troubleshoot issues within major EHR systems, including Oracle Health, EPIC, or Cerner.
• Stay current with CMS regulations and payer-specific billing guidelines for pharmacy charges and facility billing.
• Collaborate with IT and clinical departments to identify workflow issues and improve charge capture processes.

Qualifications/Specifications

Education:  Associate’s or Bachelor’s degree in healthcare administration, finance, or related field preferred.

License/Certifications:  non required

Experience:

• 3+ years of experience in facility/hospital billing, with direct experience in pharmacy billing and CDM maintenance.
• Proficiency in Oracle Health (Cerner), EPIC, or similar EHR platforms
• Strong understanding of billing codes (HCPCS, CPT, Revenue Codes) and UB-04 claim forms.
• Familiarity with self-administered drug (SAD) billing and NDC-to-HCPCS conversion.
• Excellent analytical skills and attention to detail.
• Ability to work independently and manage multiple priorities in a fast-paced environment.

Preferred Experience

• Experience working with vendors such as PharNet is a plus.
• This includes coordination between Pharmacy, Revenue Integrity, and IT to ensure accurate medication charge capture through PharNet’s interface.
• Understanding how PharNet integrates with the EHR system to route medication usage data, assign appropriate HCPCS codes, and update CDM tables.
• Resolving discrepancies between dispensed vs. billed medications, and escalating issues involving drug mapping, pricing errors, or interface failures.
• Familiarity with revenue integrity or charge reconciliation software.
• Certification (e.g., CPB, CPC, or CHRI) is a plus.
• Working knowledge of payer-specific drug billing policies (e.g., Medicare, Medicaid, commercial plans).