Insurance Billing Specialist, Full-time

Insurance Billing Specialist Onsite

Full-Time | Onsite in Hopedale, Illinois

Please note: This is an onsite position. Candidates must be willing and able to reasonably commute to Hopedale, Illinois. This position is not remote.

At Hopedale Medical Complex, healthcare is personaland every member of our team plays a part in keeping exceptional care close to home.

Join the HMC Team!

Hopedale Medical Complex is seeking an experienced Insurance Billing Specialist to join our Revenue Cycle/Patient Financial Services team.

The Insurance Billing Specialist plays an important role in ensuring accurate and timely reimbursement for hospital and hospital-based services. This position is responsible for insurance claim submission, account follow-up, denial resolution, payment review, accounts receivable management, and communication with patients, insurance companies, and internal departments.

The ideal candidate is detail-oriented, organized, dependable, and comfortable working independently while managing multiple priorities. Strong problem-solving skills and professional communication are essential to success in this role.

Position Summary

The Insurance Billing Specialist is responsible for obtaining accurate and timely reimbursement for hospital and hospital-based services. This position manages the insurance billing process from claim preparation and submission through payment, denial resolution, and account follow-up.

The Insurance Billing Specialist must maintain a thorough understanding of third-party reimbursement requirements, payer guidelines, and HMC billing policies and procedures while providing professional and courteous service to patients, insurance representatives, physicians, and hospital staff.

Essential Responsibilities

Insurance Claim Billing

• Review patient accounts to verify that services, charges, demographic information, insurance information, and other billing data are accurate and complete.
• Ensure all required information is documented to support accurate and timely claim submission.
• Run daily insurance billing reports and identify and correct discrepancies as necessary.
• Generate and submit Medicare, Medicaid, and commercial insurance claims through electronic and paper-based processes as appropriate.
• Review claims prior to submission for accuracy, completeness, and missing information.
• Transmit electronic claims through established billing systems, including TruBridge.
• Maintain knowledge of payer-specific billing requirements and claim submission guidelines.

Insurance Claim Follow-Up & Denials

• Monitor unpaid claims and perform timely follow-up to facilitate payment.
• Review insurance denials and determine appropriate steps to resolve billing discrepancies.
• Communicate with insurance companies, patients, physicians, and internal departments to obtain additional information needed for claim resolution.
• Obtain and submit supporting documentation for claim appeals when necessary.
• Re-bill claims and make account corrections as appropriate.
• Document all collection and follow-up activity accurately in the CPSI system.
• Monitor outstanding claims and take appropriate action to prevent unnecessary delays in reimbursement.

Insurance Payment Review

• Receive and prepare incoming insurance payments for posting.
• Review explanations of benefits (EOBs) and verify patient information, payer information, dates of service, and payment amounts.
• Compare insurance payments to applicable contract terms and reimbursement agreements.
• Calculate contractual allowances and adjustments as needed.
• Identify underpayments, overpayments, and other payment discrepancies and take appropriate action.
• Prepare refund requests for applicable patient or insurance overpayments.
• Forward non-collectible accounts to the Revenue Cycle Director with appropriate supporting documentation.

Accounts Receivable Management

• Monitor and maintain assigned accounts receivable balances.
• Work assigned accounts consistently and perform timely follow-up.
• Identify aging accounts and take appropriate steps to resolve outstanding balances.
• Monitor and resolve credit balances.
• Maintain accurate documentation of account activity and follow-up efforts.
• Escalate accounts requiring additional review or management intervention.

Patient & Insurance Customer Service

• Assist patients with questions regarding billing procedures, charges, insurance reimbursement, itemized statements, split billing, payments, and account balances.
• Communicate professionally with insurance companies and third-party representatives regarding claims and reimbursement.
• Provide accurate information while maintaining patient confidentiality and HIPAA compliance.
• Maintain a professional and courteous telephone presence.

Additional Responsibilities

• Maintain current knowledge of Medicare, Medicaid, commercial insurance, and other third-party billing requirements.
• Serve as a resource to staff regarding insurance billing and reimbursement questions.
• Assist with training and education of staff as needed.
• Participate in quality improvement initiatives and departmental projects.
• Maintain confidentiality of patient, financial, and organizational information.
• Perform other duties as assigned.

Qualifications

Required

• High school diploma or equivalent required.
• Knowledge of medical billing and collection procedures.
• Knowledge of Medicare, Medicaid, and commercial insurance processes.
• Strong attention to detail and organizational skills.
• Excellent verbal and written communication skills.
• Strong problem-solving and analytical abilities.
• Ability to work independently with general supervision.
• Ability to prioritize and manage multiple tasks while meeting deadlines.
• Professional telephone skills and customer service abilities.
• Proficiency with Microsoft Office applications, including Word, Excel, and Outlook.
• Ability to communicate effectively with patients, physicians, hospital staff, colleagues, and third-party insurance representatives.

Preferred

• One to two years of experience in a medical business office, patient financial services, or insurance billing environment.
• Experience with insurance claim follow-up and denial management.
• Some college coursework in healthcare administration, business, accounting, or a related field.
• Experience with computerized medical information or billing systems.
• Experience with TruBridge, CPSI, or similar healthcare revenue cycle systems.

Physical Requirements

The physical demands described below are representative of those required to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform these functions.

• Frequently: Sitting, standing, walking, talking, hearing, keyboarding, and using a computer for extended periods.
• Frequently: Repetitive hand and wrist movements associated with typing, data entry, filing, and computer use.
• Frequently: Near visual acuity required for reviewing patient accounts, insurance information, medical records, correspondence, and computer screens.
• Occasionally: Bending, reaching, stooping, and lifting or carrying office materials and supplies.
• Ability to communicate effectively in person, by telephone, and in writing.
• Ability to remain seated and focused while performing detailed computer and account review work.
• Ability to maintain accuracy while working with confidential and detailed financial and patient information.

Work Environment

Work is performed in an office environment within a healthcare facility. The position involves frequent interaction with patients, insurance representatives, physicians, hospital staff, and other members of the Revenue Cycle team.

The employee is expected to maintain a professional, organized, and confidential work environment and comply with all applicable Hopedale Medical Complex policies, HIPAA requirements, and regulatory standards.

Pre-Employment Requirements

Employment is contingent upon successfully completing Hopedale Medical Complex's required pre-employment processes, including:

• Federal and state background checks
• Drug and alcohol screening

Hopedale Medical Complex tests for both illegal and legal substances, including cannabis (THC).

Hopedale Medical Complex