Insurance Billing Specialist-Full Time
Description
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.