✔ Own the Facility Billing Process (UB‑04)

• Prepare, review, and submit hospital (UB‑04) claims for inpatient, outpatient, and procedural services.
• Validate that charges, units, revenue codes, modifiers, and documentation are correct and complete before submission.
• Scrub claims and correct edits related to coverage, coding, authorization, medical necessity, or clinical documentation.
• Review rejections and resolve issues to ensure timely, compliant claim submission.

✔ Manage Hospital Accounts Receivable With Precision

• Conduct thorough follow‑up with third‑party payers on outstanding or denied hospital accounts.
• Research payer rules and reimbursement methodologies (DRG, APC, per diem, carve-outs) and apply them to claim resolution.
• Resolve inpatient and outpatient claim discrepancies quickly to reduce AR aging.
• Process, post, and balance payments and adjustments accurately and in the correct period.

✔ Support Charge Capture & Revenue Integrity

• Coordinate closely with inpatient, outpatient, emergency, and procedural areas to validate accurate charge entry.
• Identify missing, incorrect, or duplicate charges and collaborate with departments to correct them.
• Assist with maintaining and updating the hospital charge master, ensuring rates, codes, and descriptions stay accurate and competitive.

✔ Strengthen Billing Operations & Systems

• Maintain and update billing templates, payer information, and physician/departmental billing requirements.
• Ensure information flows correctly between charge systems, billing systems, and payer portals.
• Support system updates and test new workflows that improve speed, accuracy, or compliance.

✔ Collaborate Across Departments

• Act as a liaison between Hospital Billing Operations and key departments such as Access Services, Admitting, Outpatient Surgery, Outpatient Departments, Payer Relations, Cash Applications, and Physician Billing Services.
• Provide insight on payer requirements and help clinical teams understand how documentation impacts reimbursement.
• Assist as a resource for new team members and serve as a subject matter expert for non‑routine billing situations.

✔ Maintain the Highest Quality Standards

• Produce and review quality assurance reports to ensure billing accuracy and compliance.
• Support utilization review activities by coordinating with UR teams and payers as needed.
• Uphold integrity and compliance across all billing actions, following hospital and regulatory guidelines.

Why This Role Matters

You help ensure Cincinnati Children’s receives accurate reimbursement — supporting the lifesaving care we provide every day. Your work:

• Reduces financial stress for families
• Supports operational excellence and compliance
• Ensures clinical documentation is reflected correctly
• Helps maintain the hospital’s financial strength and sustainability

You’re not just billing — you’re part of the care team.

About Us