Insurance Billing Specialist-Full Time

Croix Health; Northern (KY); Hybrid; USD 38,000 - 54,000; Full time

Benefits offered by this job

Health insurance

Vision insurance

Dental insurance

403b retirement with employer match

Paid time off

Disability insurance

Education reimbursement

Employee assistance program (EAP)

Wellbeing incentive program

Free parking

Job summary

St. Croix Health is seeking an Insurance Billing Specialist to join our team. This role focuses on processing medical insurance claims, ensuring maximum reimbursement, and resolving holds and denials across Rural Health and Critical Access facilities.

The position requires strong attention to detail, effective communication, and the ability to work with various payers and billing systems; familiarity with UB04/837 I and HCFA 1500/837P is a plus.

Qualifications

• High school diploma required; an associate degree in medical administration or related field is preferred.
• Experience with billing in healthcare and knowledge of claims processing is expected.
• Experience with electronic medical records and billing systems is preferred.

Responsibilities

• Process insurance claims and ensure accurate submission.
• Follow-up on unpaid or underpaid claims and monitor aging.
• Review and appeal denials by payer policies.
• Assist patients with billing questions and explanations of benefits.

Skills

Billing

Microsoft Office

Communication

Prioritization

Adaptability

Education

High school diploma

Associate degree

Healthcare experience

Tools

EMR systems

Billing software

Job description

Description

St. Croix Health is currently seeking a detail-oriented, motivated Insurance Billing Specialist to join our growing team!

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

* While this job description is intended to be an accurate reflection of the job requirements, management reserves the right to modify, add or remove duties from particular jobs and to assign other duties as necessary.

Requirements

Education & Licensure:

• High school graduates required


• Associate’s degree in medical administration or related field preferred


• If no degree, healthcare experience required

Experience:

• 1-2 years of billing or charge entry experience in healthcare is preferred


• Experience with electronic medical records and billing systems


• Experience in a healthcare business office

Knowledge, Skills & Abilities:

• 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

Role-specific Competencies:

• 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 payer remittance advice

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer


• Prolonged periods of standing, bending, and reaching


• Must be able to lift up to 15 pounds at times

St. Croix Health is an Equal Opportunity Employer.

We will ensure that individuals with disabilities are provided with reasonable accommodation throughout the hiring process. If reasonable accommodations are needed, please contact us at [e-mail] or 800-828-3627

St. Croix Health has been a healing force in the St. Croix Valley for over 103 years. We are a purpose-driven organization with a dedicated team committed to serving our patients and communities throughout the St. Croix Valley. This commitment is rooted in our mission, vision and values.

Mission: To deliver care driven by excellence, guided by heart, and grounded in community.

Vision: To be a trusted partner in providing healthcare that is personal and accessible to all, by adapting to meet the needs of our communities, and support lifelong well-being.

Values: Integrity. Respect. Compassion. Collaboration

Here at St. Croix Health, we offer our employees with a robust benefits package that includes:

• Health, vision and dental insurance


• 403b retirement program with employer match


• Paid time off


• Short-term disability, long-term disability and life insurance options


• Education reimbursement


• Employee assistance program (EAP)


• Wellbeing incentive program


• Free parking

St. Croix Health is a not-for-profit healthcare system located in St. Croix Falls, WI dedicated to helping people live healthier, happier, and longer lives. St. Croix Health offers the services of 80+ providers and 20 specialties with five community clinics in Minnesota and Wisconsin all supported by a critical access hospital on the main campus in St. Croix Falls, just an hour northeast of Minneapolis/St. Paul. Nestled in the bluffs of the St. Croix River Valley, St. Croix Falls is the ideal place to work, live and play.