Job Summary

The Hospital Billing Executive UB-04 is responsible for preparing, reviewing, and submitting institutional claims using the UB-04 (CMS-1450) claim form for hospitals, skilled nursing facilities, rehabilitation centers, and other institutional healthcare providers. The role ensures accurate coding, timely claim submission, compliance with payer requirements, and prompt reimbursement while minimizing claim denials.

Key Responsibilities

- Prepare and submit UB-04 (CMS-1450) institutional claims accurately and within established turnaround times.
- Review patient demographics, insurance eligibility, authorizations, and registration details before claim submission.
- Validate revenue codes, occurrence codes, condition codes, value codes, and bill types.
- Verify ICD-10-CM diagnosis codes, ICD-10-PCS (for inpatient procedures), HCPCS/CPT codes, and modifiers as applicable.
- Ensure accurate charge capture and reconciliation with medical records.
- Submit electronic claims through payer portals or clearinghouses.




- Review and resolve claim edits, rejections, and denials related to UB-04 billing.
- Coordinate with coding, registration, utilization review, and clinical teams to obtain missing documentation.
- Follow up on unpaid, denied, or partially paid claims to maximize reimbursement.
- Maintain compliance with CMS regulations, HIPAA guidelines, payer policies, and client-specific requirements.
- Analyze Explanation of Advantages (EOBs) and Electronic Remittance Advice (ERA) to identify payment discrepancies.
- Process corrected claims, adjusted claims, and claim appeals as required.
- Meet productivity, quality, and accuracy targets established by the organization.
- Prepare daily and monthly billing reports and maintain accurate billing records.
- - - - - interested candidates can reach me through phone or whatsapp :(phone hidden) - pranavi

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