Insurance Billing Specialist, Full-time

Hopedale Medical Complex•Hopedale, IL

9d•$24 - $25•Onsite

About The Position

Hopedale Medical Complex is seeking an experienced Insurance Billing Specialist to join our Patient Financial Services team. This position is responsible for obtaining accurate, ethical, and timely reimbursement for hospital and hospital-based services and managing all aspects of insurance claim billing and follow-up. The Insurance Billing Specialist processes insurance claims, researches and resolves denials and discrepancies, follows up on outstanding accounts, reviews insurance payments, manages assigned accounts receivable, and assists patients and insurance companies with billing-related questions. The successful candidate will have strong problem-solving and organizational skills, exceptional attention to detail, excellent telephone and customer service skills, and the ability to work independently while maintaining accuracy and productivity. This is an onsite position in Hopedale, Illinois. Candidates must be willing and able to reasonably commute to the Hopedale Medical Complex campus. This position is not eligible for remote work.

Requirements

High school diploma or equivalent required.
One to two years of experience in a medical business office, preferably with experience in insurance claim billing and follow-up.
Working knowledge of Medicare Part A, Medicaid, and commercial insurance billing procedures.
Knowledge of medical billing and collection procedures.
Demonstrated working knowledge of computerized medical information management systems.
Proficiency with Microsoft Office applications, including Word, Excel, and Outlook.
Strong verbal and written communication skills.
Excellent telephone communication and customer service skills.
Strong organizational skills and exceptional attention to detail.
Ability to analyze billing issues, identify discrepancies, and resolve problems effectively.
Ability to work independently with general supervision.
High level of dependability, accuracy, and accountability.
Ability to effectively communicate and interact with colleagues, hospital staff, patients, physicians and their office staff, and third-party insurance representatives.
Ability and willingness to work onsite at Hopedale Medical Complex in Hopedale, Illinois.

Nice To Haves

Some college coursework preferred.
Previous experience with hospital billing and hospital-based services preferred.
Experience with Medicare, Medicaid, and commercial insurance claim follow-up preferred.
Experience with UB-04 claims preferred.
Experience with CPSI, TruBridge, or similar healthcare billing systems preferred.
Experience working with insurance denials, appeals, contractual allowances, and accounts receivable preferred.

Responsibilities

Review patient accounts and verify data to ensure services, charges, and billing information are accurate and complete.
Ensure all pertinent billing information is documented to support accurate and timely submission of clean UB-04 claims.
Run daily insurance billing reports and review accounts for discrepancies or missing information.
Correct accounts and billing information as necessary prior to claim submission.
Generate Medicare, Medicaid, and commercial insurance claims through electronic and hard-copy processes as required.
Review claims for accuracy, completeness, and required information prior to submission.
Submit electronic claims through TruBridge and other applicable billing systems.
Follow established HMC billing policies, procedures, and payer requirements.
Monitor and follow up on unpaid and outstanding insurance claims.
Research and resolve insurance claim denials, rejections, and payment discrepancies.
Communicate discrepancies and requests for additional information to appropriate departments, staff, providers, patients, or other parties.
Obtain supporting documentation and information needed to appeal denied or underpaid claims.
Document all collection and claim follow-up activity accurately and timely in the CPSI system.
Rebill accounts as necessary.
Maintain appropriate documentation of claim status and follow-up efforts.
Receive and review daily insurance payments and prepare transactions for posting.
Review explanations of benefits (EOBs) and verify patient information, payer information, dates of service, and payment details.
Audit insurance payments against applicable contract terms and reimbursement requirements.
Calculate contractual allowances as necessary.
Identify non-collectible accounts and forward them to the Revenue Cycle Director for review and appropriate action, including write-off requests, when applicable.
Assist patients and insurance companies with questions regarding billing procedures, charges, insurance reimbursement, itemized statements, split billings, payments, and other account-related matters.
Monitor and maintain assigned accounts receivable in accordance with departmental goals and procedures.
Regularly review and follow up on assigned accounts to promote timely resolution and payment.
Identify and resolve credit balances in a timely manner.
Generate refund requests for overpayments in accordance with established procedures.
Maintain accurate documentation of account activity and follow-up.
Maintain current knowledge of Medicare, Medicaid, commercial insurance, and other third-party billing and reimbursement requirements.
Stay informed of changes to payer requirements, billing regulations, and applicable HMC policies and procedures.
Serve as a resource to staff regarding insurance billing and reimbursement questions.
Assist with training staff on insurance billing processes and procedures as needed.
Participate in departmental quality improvement activities and process improvement initiatives as assigned.
Perform other duties as assigned.