St. Croix Regional Medical Center

Nonprofit critical access hospital and clinic network

Insurance Billing Specialist

Accounts Payable/ReceivableConfirmed live in the last 24 hours

Full-timeSt Croix Falls, WI, USANo salary listed

About the Job

Requirements

High school graduation is required.
If the candidate does not have a degree, healthcare experience is required.
Experience with electronic medical records and billing systems is required.
Experience in a healthcare business office is required.
Basic computer skills, including Microsoft Office products, are required.
Ability to assess and prioritize workload is required.
Interpersonal, verbal, and written communication skills are required.
Ability to adapt to change is required.
Ability to take ownership of expectations and goals, complete them in a timely manner, and seek supervision appropriately is required.
Knowledge of insurance billing, including UB04/837 I and HCFA 1500/837P claims processing and insurance terminology, is required.
Understanding of Critical Access and Rural Health billing is required.
Knowledge of Medicare, Medicaid, HMO, and private payer billing rules and regulations is required.
Ability to interpret and understand payer remittance advice is required.
Ability to sit at a desk and work on a computer for prolonged periods is required.
Ability to stand, bend, and reach for prolonged periods is required.
Ability to lift up to 15 pounds at times is required.

Responsibilities

Process insurance claims, ensuring appropriate claim processing.
Verify patient eligibility or coverage as needed for all payors.
Apply knowledge of UB and 1500 claim elements that affect processing.
Submit claims accurately and timely in accordance with accounts receivable goals.
Follow up on unpaid claims and underpaid encounters.
Work billing queues in a timely manner.
Manage account aging and incoming correspondence with timely and appropriate follow-up.
Follow up on denials by analyzing and researching payer-specific coverage and reimbursement policies.
Analyze denial reasons and work toward appropriate resolution.
Apply knowledge of payer appeal processes.
Assist patients with billing questions and concerns.
Apply knowledge of insurance explanations of benefits.
Work with insurance providers and member services to support patient understanding and claim processing.
Bill medical claims to insurance and ensure maximum payment and reimbursement.
Resolve clinic- and hospital-related claim holds, denials, and incorrect billing information.
Monitor claim status, filing limits, and Medicare, Medicaid, and commercial plan billing policies.
Manage billing for St. Croix Regional Medical Center claims, including Rural Health and Critical Access claims.

Desired Qualifications

An associate’s degree in medical administration or a related field is preferred.
One to two years of healthcare billing or charge-entry experience is preferred.

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.

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.

Requirements

Education & Licensure:

High school graduates required
Associate’s 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 payer remittance advice

Physical Requirements:

Prolonged periods of sitting at a desk and working on a computer
Prolonged periods of standing, bending, and reaching
Must be able to lift up to 15 pounds at times

St. 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 [email protected] or 800-828-3627

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.

About the Company

St. Croix Regional Medical Center

Nonprofit critical access hospital and clinic network

St. Croix Regional Medical Center is the flagship hospital of St. Croix Health, a nonprofit critical access system serving Burnett, Barron, Polk, and St. Croix counties in Wisconsin and Chisago County in Minnesota. It provides emergency care, acute stroke-ready treatment, surgery, imaging, laboratory, and inpatient services, plus a network of community clinics and pharmacies offering primary care, cardiology, orthopedics, oncology, and behavioral health. What sets St. Croix Regional Medical Center apart is its century-long presence dating to 1919 and its rural, close-to-home care model spanning the Wisconsin-Minnesota border. The goal is to deliver excellent, compassionate care that keeps comprehensive health services accessible to the communities it serves.

Company size: Not listed
Company stage: Not listed
Total funding: Not listed
Headquarters: Santa Clarita, CA
Founded: 2010

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