Description

St. Croix Health is looking for a full-time (1.0 FTE) Insurance Billing Specialist to join our team. Will work Monday through Friday, day hours. This position will work 100% onsite during the training period (approximately first 1 - 3 months of employment). Once training is complete, will move to remote with occasional onsite meetings. 

Job Summary:

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 monitors claim status, filing limits, policies, procedures and regulations for Medicare, Medicaid and Commercial plan billing practices. This position is responsible for Inpatient, Outpatient and Clinic claims with variety of over 30 specialties including Rural Health and Critical Access regulatory requirements and restrictions. 

Essential Duties and Responsibilities:

1. Process insurance claims

• Expert knowledge of all payer, critical access, rural health, and provider based rules, regulations and billing policies to ensure appropriate processing of claims
• Verify patient eligibility or coverage as needed, both primary and secondary
• Ensure appropriate modifiers are used per payer guidance
• Expert knowledge of revenue codes and appropriate processes and policies for splitting charges (if needed)
• Evaluation if charge splitting is appropriate for service represented on the claim
• Accountable for accurate and timely claim submissions to maintain a steady positive operating cash flow

2. Follow-up on claim denials and follow-up on all unpaid and/or underpaid encounters

• Works billing queues timely
• Analyze, research, and navigate payer specific coverage and reimbursement policies
• Understand and articulate payer specific contracting agreements
• Expert knowledge of payer denial codes
• Accountable to analyze reason for denial and to work towards appropriate resolution
• Expert knowledge of appeal process by payer
• Accountable for biller aging and incoming correspondence timely and appropriate follow-up

3. Identify trends and work towards resolution

• Works with internal departments to optimize charging/billing workflows to ensure maximum automation of clean claims
• Works with system trainer to improve claims processing, work que functionality, and overall efficiency of revenue cycle
• Works with external payer representatives to ensure accuracy of reimbursement

4. Assists patients with billing questions and concerns

• Expert knowledge of all insurance explanation of benefits
• Ability to work with insurance provider and member services to ensure patient understanding 

Requirements

Education & Licensure:

• High school diploma required
• Associates 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 preferred
• Experience in a healthcare business office preferred

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 
• 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 of payer remittance advices 

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times. 

St. Croix Health is an Equal Opportunity Employer.

St. 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

We help people live healthier, happier, and longer lives.

Vision

To transform from quality sick care to quality well care that is sustainable and affordable.

Values

People Centered, Trust, Innovation, and Growth.

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
• Employee prescription discount program

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.