Insurance Billing Specialist

St. Croix Health is looking for a full-time (1.0 FTE) Insurance Billing Specialist to join our team. This position will work Monday through Friday, day hours. This position will work 100% onsite at our St. Croix Falls, WI location during the training period (approximately first 1 - 3 months of employment). Once training is complete, possibility to move to hybrid. Hybrid employees are required to live within a commutable distance from our primary location in St. Croix Falls as on-site workdays, meetings and trainings are required.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 claimsExpert knowledge of all payer, critical access, rural health, and provider based rules, regulations and billing policies to ensure appropriate processing of claimsVerify patient eligibility or coverage as needed, both primary and secondaryEnsure appropriate modifiers are used per payer guidanceExpert 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 claimAccountable for accurate and timely claim submissions to maintain a steady positive operating cash flow2. Follow-up on claim denials and follow-up on all unpaid and/or underpaid encountersWorks billing queues timelyAnalyze, research, and navigate payer specific coverage and reimbursement policiesUnderstand and articulate payer specific contracting agreementsExpert knowledge of payer denial codesAccountable to analyze reason for denial and to work towards appropriate resolutionExpert knowledge of appeal process by payerAccountable for biller aging and incoming correspondence timely and appropriate follow-up3. Identify trends and work towards resolutionWorks with internal departments to optimize charging/billing workflows to ensure maximum automation of clean claimsWorks with system trainer to improve claims processing, work que functionality, and overall efficiency of revenue cycleWorks with external payer representatives to ensure accuracy of reimbursement4. Assists patients with billing questions and concernsExpert knowledge of all insurance explanation of benefitsAbility to work with insurance provider and member services to ensure patient understandingRequirementsEducation & Licensure:High school graduate requiredAssociates degree in Medical Administration or related field preferredHealthcare experience required without secondary degreeExperience:Minimum 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::Intermediate/Advanced computer skills, including but not limited to Microsoft Office productsExcellent interpersonal, verbal, and written communication skillsUnderstanding of Critical Access and Rural Health billingAbility to deal effectively and assertively with a broad range of people under varying pressure situationsAdaptability to constantly changing processes, software systems, and payer programsMedical billing background to include knowledge of ANSI codes, CPT, and HCPCS codes, insurance terminologyKnowledge of insurance billing both UB92/8371 and HCFA 1500/837P claims processingHigh level interpretation and understanding of payer remittance advices in both paper and electronic formatsExceptional knowledge of Medicare, Medicaid, HMO, and private payer billing rules and regulationsSelf-motivated, takes ownership in expectations/goals, and sees them through in a timely manner, and seeks supervision appropriatelyPhysical 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. We will ensure that persons with disabilities are provided reasonable accommodations for the hiring process. If reasonable accommodation is needed, please contact us at HR@scrmc.org or 800-828-3627. 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 insurance403b retirement program with employer matchPaid time offShort-term disability, long-term disability and life insurance optionsEducation reimbursementEmployee assistance program (EAP)Wellbeing incentive programFree parking