Insurance Billing Specialist-Full Time

Description St. Croix Health is currently seeking a detail‑oriented, motivated Insurance Billing Specialist to join our growing team! This is a full‑time (1.0 FTE), Monday – Friday daytime position, offering a healthy work‑life balance. Hybrid Work Opportunity! Start your journey with hands‑on training at our St. Croix Falls, WI location, where you will work onsite for the first 1‑3 months of employment. After successful completion of training, employees may transition to a hybrid schedule. Hybrid employees must live within a commutable distance of St. Croix Falls, WI to attend required onsite workdays, meetings and trainings. Join a supportive, growing team where your skills and contributions truly make an impact! 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. Requirements 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. Equal Opportunity Employer 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 View email address on click.appcast.io or View phone number on click.appcast.io. Benefits 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 #J-18808-Ljbffr St Croix Health