Insurance Billing Specialist-Full Time

St Croix Health•St. Croix Falls, WI

2d•Hybrid

About The Position

St. Croix Health is currently seeking a detail-oriented, motivated Insurance Billing Specialist to join their growing team. This is a full-time (1.0 FTE), Monday – Friday daytime position, offering a healthy work-life balance. This role offers a hybrid work opportunity. Employees will start with hands-on training at the St. Croix Falls, WI location, working onsite for the first 1-3 months. After successful completion of training, employees may have the opportunity to transition to a hybrid work schedule, requiring them to live within a commutable distance of St. Croix Falls, WI for required onsite workdays, meetings, and trainings. The Insurance Billing Specialist is responsible for billing medical claims to insurance and ensuring maximum payment and reimbursement of claims. This position resolves clinic and hospital related claim holds, denials, and incorrect billing information. They monitor claim status, filing limits, and policies for Medicare, Medicaid, and Commercial plan billing practices. This Insurance Billing Specialist is responsible for all billing for St. Croix Regional Medical Center claims, including Rural Health and Critical Access.

Requirements

High school graduate required
Experience with electronic medical records and billing systems
Experience in a healthcare business office
Basic computer skills, including but not limited to Microsoft Office products
Ability to assess and prioritize workload
Excellent interpersonal, verbal, and written communication skills
Adaptability to change
Self-motivated, takes ownership in expectations/goals, and sees them through in a timely manner, and seeks supervision appropriately
Knowledge of insurance billing both UB04/837 I and HCFA 1500/837P claims processing & insurance terminology
Understanding of Critical Access and Rural Health billing
Knowledge of Medicare, Medicaid, HMO, and private payer billing rules and regulations
Ability to interpret and understand of payer remittance advices
Prolonged periods of sitting at a desk and working on a computer.
Must be able to lift up to 15 pounds at times.

Nice To Haves

Associates degree in Medical Administration or related field preferred.
If no degree, healthcare experience required.
1-2 years of billing or charge entry experience in healthcare is preferred
Knowledge of UB and 1500 claim elements impacting processing
Knowledge of appeal process by payer
Knowledge of all insurance explanation of benefits
Ability to work with insurance provider and member services to ensure patient understanding and claim processing

Responsibilities

Process insurance claims
Ensure appropriate processing of claims
Verify patient eligibility or coverage as needed for all payors
Accountable for accurate and timely claim submissions in accordance with A/R goals
Follow-up on all unpaid claims and/or underpaid encounters
Works billing queues timely
Accountable for account aging and incoming correspondence timely and appropriate follow-up
Follow-up on denials
Analyze, research, and navigate payer specific coverage and reimbursement policies
Accountable to analyze reason for denial and to work towards appropriate resolution
Assists patients with billing questions and concerns