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Job description
Insurance Billing SpecialistSt. 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 claimsEnsure appropriate processing of claimsVerify patient eligibility or coverage as needed for all payorsKnowledge of UB and 1500 claim elements impacting processingAccountable for accurate and timely claim submissions in accordance with A/R goalsFollow-up on all unpaid claims and/or underpaid encountersWorks billing queues timelyAccountable for account aging and incoming correspondence timely and appropriate follow-upFollow-up on denialsAnalyze, research, and navigate payer specific coverage and reimbursement policiesAccountable to analyze reason for denial and to work towards appropriate resolutionKnowledge of appeal process by payerAssist patients with billing questions and concernsKnowledge of all insurance explanations of benefitsAbility to work with insurance provider and member services to ensure patient understanding and claim processingRequirementsEducation & Licensure:High school graduates requiredAssociate's degree in medical administration or related field preferredIf no degree, healthcare experience requiredExperience:1-2 years of billing or charge entry experience in healthcare is preferredExperience with electronic medical records and billing systemsExperience in a healthcare business officeKnowledge, Skills & Abilities:Basic computer skills, including but not limited to Microsoft Office productsAbility to assess and prioritize workloadExcellent interpersonal, verbal, and written communication skillsAdaptability to changeSelf-motivated, takes ownership in expectations/goals, and sees them through in a timely manner, and seeks supervision appropriatelyRole-specific Competencies:Knowledge of insurance billing both UB04/837 I and HCFA 1500/837P claims processing & insurance terminologyUnderstanding of Critical Access and Rural Health billingKnowledge of Medicare, Medicaid, HMO, and private payer billing rules and regulationsAbility to interpret and understand payer remittance advicePhysical Requirements:Prolonged periods of sitting at a desk and working on a computerProlonged periods of standing, bending, and reachingMust be able to lift up to 15 pounds at timesSt. 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 or 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. CollaborationHere at St. Croix Health, we offer our employees with a robust benefits package that includes:Health, vision and dental insurance403b retirement program with employer matchPaid time offShort-term disability, long-term disability and life insurance optionsEducation reimbursementEmployee assistance program (EAP)Wellbeing incentive programFree parkingSt. 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.
Worksite address
saint croix falls, WI, 54024, US
Who can apply
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