INSURANCE BILLING SPECIALIST

Memorial Regional Health • Craig, CO

2d

About The Position

This role is responsible for processing and submitting health insurance claims accurately and efficiently. The specialist will ensure correct coding, resolve claim denials, and maintain knowledge of various insurance guidelines. Additionally, the position involves patient communication regarding billing inquiries and maintaining detailed records in the EMR system. The role also emphasizes adherence to organizational values, effective communication, and compliance with all regulatory and safety standards.

Requirements

• Must be at least 18 years of age.
• Must be legally authorized to work in the United States.
• Must successfully pass a background check.
• Must successfully pass a pre-employment drug screen and breath alcohol test (if applicable).
• Must complete an Employee Health meeting prior to starting employment.

Responsibilities

• Processes and submits health insurance claims to various insurance companies in a timely and accurate manner.
• Ensures claims are coded correctly in compliance with the latest medical coding and billing guidelines (CPT, ICD-10, HCPCS).
• Collaborates with the coding and clinical departments to resolve edits and denials.
• Maintains a working knowledge of Medicare and Medicaid as well as commercial payer guidelines and stays abreast of new policy changes.
• Verifies patient eligibility and coverage details before claim submission and reconciles coverage denials when necessary.
• Resolves claim edits both in the electronic medical record (EMR) and in the clearinghouse to prevent denials.
• Follows up with insurance companies regarding denied or underpaid claims and submits appeals when appropriate.
• Reviews insurance and patient credit balances and resolves them in a timely manner.
• Educates patients on their billing inquiries, providing clear and accurate explanations regarding their insurance coverage and payment responsibilities.
• Documents all actions taken with an account in the electronic medical record (EMR).
• Performs other duties as assigned.
• Demonstrates full commitment to the CHOICE values of MRH and consistently represents the organization in a positive, professional manner.
• Establishes and maintains effective verbal and written communication, fostering positive working relationships with patients, staff, and vendors.
• Adheres to the MRH attire and dress code in accordance with organizational policies and procedures.
• Exhibits initiative and self-motivation; maintains a consistent level of productivity and manages time and responsibilities effectively.
• Completes all required annual education, training, in-services, and licensure/certification updates; actively participates in departmental and organizational meetings or reviews meeting minutes as required.
• Maintains strict patient confidentiality at all times.
• Reports to work punctually and completes assigned duties within established timeframes.
• Actively contributes to departmental and organization-wide performance improvement and continuous quality initiatives.
• Ensures compliance with all regulatory requirements, maintaining adherence to departmental, hospital, state, and federal standards and policies.
• Follows all infection control, safety, and risk management procedures to maintain a safe environment for patients, the public, and staff.

What This Job Offers

• Education Level: No Education Listed