Insurance Billing Specialist-Full Time

St Croix Health•St. Croix Falls, WI

20d

About The Position

St. Croix Health is seeking a detail-oriented, motivated Insurance Billing Specialist to bill medical claims to insurance and help maximize claim payment and reimbursement. The role resolves clinic- and hospital-related claim holds, denials, and incorrect billing information, and monitors claim status, filing limits, and billing policies for Medicare, Medicaid, and commercial plans. The specialist handles billing for St. Croix Regional Medical Center claims, including Rural Health and Critical Access claims. The position also supports patients with billing questions and concerns, works with insurance providers and member services to promote patient understanding and claim processing, and contributes to timely and accurate account follow-up. Management may modify or reassign duties as necessary. St. Croix Health is a not-for-profit healthcare system serving communities throughout the St. Croix Valley. Its mission is to deliver care driven by excellence, guided by heart, and grounded in community; its vision is to provide personal, accessible healthcare by adapting to community needs and supporting lifelong well-being. Its stated values are integrity, respect, compassion, and collaboration.

Requirements

High school graduation is required.
If the candidate does not have a degree, healthcare experience is required.
Experience with electronic medical records and billing systems.
Experience in a healthcare business office.
Basic computer skills, including Microsoft Office products.
Ability to assess and prioritize workload.
Excellent interpersonal, verbal, and written communication skills.
Adaptability to change.
Self-motivation, ownership of expectations and goals, timely follow-through, and appropriate use of supervision.
Knowledge of insurance billing, UB04/837 I and HCFA 1500/837P claim processing, and 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 payer remittance advice.

Nice To Haves

Associate’s degree in medical administration or a related field.
1–2 years of healthcare billing or charge entry experience.

Responsibilities

Process insurance claims and ensure appropriate claim processing.
Verify patient eligibility or coverage as needed for all payors.
Submit claims accurately and on time in accordance with accounts receivable goals.
Follow up on unpaid or underpaid claims and encounters.
Work billing queues, account aging, and incoming correspondence promptly, with appropriate follow-up.
Monitor claim status, filing limits, and payer billing policies.
Resolve claim holds, denials, and incorrect billing information for clinic and hospital claims.
Analyze denial reasons, research payer-specific coverage and reimbursement policies, and pursue appropriate resolutions and appeals.
Assist patients with billing questions and concerns.
Work with insurance providers and member services to support patient understanding and claim processing.
Handle billing for St. Croix Regional Medical Center claims, including Rural Health and Critical Access claims.