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 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

Assists patients with billing questions and concerns

• Knowledge of all insurance explanation 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.

Education & Licensure:

• High school graduate 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
• 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 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 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.