Billing & Posting Representative

The Commercial Medical Biller is responsible for accurate and timely billing of hospital and Rural Health Clinic (RHC) claims to commercial 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 commercial 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 commercial payer policy updates and RHC billing changes.

Required Skills & Qualifications

• Knowledge of hospital and RHC billing processes.

• Strong experience with commercial 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.

Business Support

See what healthcare leaders are saying about TruBridge When the CEO knows my name, it says something that’s unique for a company of their size. Grady Swann, CIO Franklin County Memorial Hospital, Meadville, MS TruBridge’s experience in the area of AR recovery, along with their professional but aggressive project plan, enabled them to exceed the goal and therefore exceed our expectations. We knew with the right partner we could generate higher recoveries on AR than a sale of it to a collections firm. TruBridge did that – and then some. Chriss Goff, Managing Director of Corporate Finance and Restructuring FTI Consulting Being able to connect our EHR with our financial data helps streamline the flow of information between our clinical and front-office teams. The result is better communication and ultimately a better experience for the patients we service. Loretta Wilson, CEO Hill Hospital of Sumter County Our biggest challenge: cash flow. We didn’t have the time or resources to track our claims. This RCM was a game changer. Shannon Lucas, Director of Field Accounting Preferred Care, Plano, TX Simply put, TruBridge has exceeded our expectations. The up-front collections service experts have always felt like a natural extension of our healthcare operations family. Their responsiveness, clear and accountable service reporting, and outstanding patient collections have helped us generate more revenue and happier patients. Door County Medical Center