Insurance Billing Associate (hybrid), full time, days

Insurance Billing Associate

The Insurance Billing Associate ensures the accurate, compliant, and timely submission of insurance claims to government and commercial payers. This role is essential to securing appropriate reimbursement, directly supporting organizational financial performance, while maintaining strict adherence to regulatory and payer requirements and safeguarding patient confidentiality and data integrity.

Job Type: Full Time, 80 hours every two weeks

Shift Length: 8 hour shifts, Mon-Fri

Wage Range: $16.88-$23.64 per hour

Requirements:

-High school diploma/GED, or higher education

-Minimum Required: Two years in hospital or professional billing or revenue cycle operations.

-Preferred: Healthcare experience and customer service experience, including face-to-face and telephone interactions.

Essential Functions

Billing

• Prepare, submit, and manage electronic and paper insurance claims to third-party payers, ensuring accuracy and compliance with payer-specific requirements and regulatory guidelines.

• Analyze and resolve claim rejections daily within the hospitals clearinghouse system to ensure timely claim submission, reduce denial risk and support optimal reimbursement.

• Analyze and resolve claim edits daily within the Hospital's EHR system to support a high first-pass clean claim rate and minimize denials.

• Thoroughly analyze denied claims and resubmit corrected claims with updated charges, coding revisions, demographic corrections, and all required information to reduce denials and maximize reimbursement. Perform additional billing-related tasks as needed, including special rebilling initiatives/projects.

Claim Resolution / Denials

• Monitor claim processing status and proactively follow up with payers if processing has not been initiated/received within 45 days; resubmit or submit new claims when necessary.

• Investigate and resolve payer claim denials within required timeframes, identify root causes, and implement corrective actions (including in the clearinghouse application when applicable) to prevent recurrence.

• Review and address both incoming patient and insurance correspondence (mail/email) within one business day, ensuring timely communication and follow-up.

• Analyze and resolve claim edits daily within the Hospital's EHR system to support a high first-pass clean claim rate and minimize denials.

• Manage payer relationships and reimbursement activities by communicating with payers through phone and secure portals, participating in payer meetings, monitoring policy changes, and preparing and submitting untimely appeals.

Reporting / Documentation

• Maintain accurate, thorough documentation of billing activity (including insurance phone calls and actions taken on each encounter) with clear, concise, and specific detail in the billing system.

• Adhere to departmental and Hospital performance metrics including A/R goals, productivity benchmarks, and quality audit requirements.

Compliance and Communication

• Maintain working knowledge of federal/state regulations and payer-specific requirements (including Medicare, Medicaid, and fiscal intermediaries) to support compliant claims submission.

• Investigate and analyze outstanding debit and credit balances within designated timeframes; collaborate with stakeholders to determine appropriate resolutions.

• Manage communications effectively (email, telephone, instant messaging) with payers and internal departments to resolve billing inquiries promptly.

• Maintain strict compliance with HIPAA guidelines to safeguard patient information and confidentiality.

• Attend mandatory internal/external training and education to remain current on best practices, coding changes, and regulatory updates.

Holland Hospital is an Equal Opportunity Employer, please see our EEO policy