Insurance Billing Specialist-Full Time
St Croix Health
Summary
St. Croix Health is currently seeking a detail-oriented, motivated Insurance Billing Specialist to join our growing team!
Job description
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 to include Rural Health and Critical Access.
Essential Duties and Responsibilities
Process insurance claims
- Ensure appropriate processing of claims
- Verify patient eligibility or coverage as needed for all payors
- Knowledge of UB and 1500 claim elements impacting processing
- 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
- Knowledge of appeal process by payer
Assist patients with billing questions and concerns
- Knowledge of all insurance explanations of benefits
- Ability to work with insurance provider and member services to ensure patient understanding and claim processing
Requirements
- High school graduate required
- Associate's 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 preferred
- 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-motivated and takes ownership of expectations/goals
- Knowledge of insurance billing both UB04/837 I and HCFA 1500/837P claims 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
Benefits
- Health, Vision & Dental Insurance
- 403(b) Retirement with Match
- Paid Time Off
- Short & Long-Term Disability
- Life Insurance
- Education Reimbursement
- Employee Assistance Program
- Wellbeing Incentive Program
- Free Parking
Company overview
St. Croix Health is a non-profit healthcare network that has been serving the St. Croix Valley region since its founding in 1919. Based in St. Croix Falls, Wisconsin, the organization operates multiple facilities across Wisconsin and Minnesota, providing comprehensive medical services to communities in the region. As a community-focused healthcare provider, St. Croix Health offers a wide range of medical specialties including family practice, internal medicine, pediatrics, surgery, OB/GYN, neurology, orthopedics, sports medicine, emergency medicine, oncology, cardiology, and numerous other medical disciplines. The organization is dedicated to building healthier communities through compassionate care and quality medicine, maintaining a strong tradition of patient-centered service. With 501-1,000 employees, St. Croix Health serves as a vital healthcare resource for residents in the St. Croix Valley area, emphasizing accessibility and positive patient experiences across all its facilities.