Insurance Billing Specialist, Full-time

Insurance Billing Specialist – Onsite

Department: Patient Financial Services
Employment Type: Full-Time
Work Location: Hopedale, Illinois
Work Arrangement: Onsite – This is not a remote position.

HMC Offers

• Excellent benefits package for eligible employees

• Quality childcare located on site

• HMC Wellness Center membership

• 401(k) plan with employer match

Job Preview

Hopedale Medical Complex is seeking an experienced Insurance Billing Specialist to join our Patient Financial Services team. This position is responsible for obtaining accurate, ethical, and timely reimbursement for hospital and hospital-based services and managing all aspects of insurance claim billing and follow-up.

The Insurance Billing Specialist processes insurance claims, researches and resolves denials and discrepancies, follows up on outstanding accounts, reviews insurance payments, manages assigned accounts receivable, and assists patients and insurance companies with billing-related questions.

The successful candidate will have strong problem-solving and organizational skills, exceptional attention to detail, excellent telephone and customer service skills, and the ability to work independently while maintaining accuracy and productivity.

This is an onsite position in Hopedale, Illinois. Candidates must be willing and able to reasonably commute to the Hopedale Medical Complex campus. This position is not eligible for remote work.

Essential Duties and Responsibilities

Insurance Claim Billing

• Review patient accounts and verify data to ensure services, charges, and billing information are accurate and complete.

• Ensure all pertinent billing information is documented to support accurate and timely submission of clean UB-04 claims.

• Run daily insurance billing reports and review accounts for discrepancies or missing information.

• Correct accounts and billing information as necessary prior to claim submission.

• Generate Medicare, Medicaid, and commercial insurance claims through electronic and hard-copy processes as required.

• Review claims for accuracy, completeness, and required information prior to submission.

• Submit electronic claims through TruBridge and other applicable billing systems.

• Follow established HMC billing policies, procedures, and payer requirements.

Insurance Claim Follow-Up

• Monitor and follow up on unpaid and outstanding insurance claims.

• Research and resolve insurance claim denials, rejections, and payment discrepancies.

• Communicate discrepancies and requests for additional information to appropriate departments, staff, providers, patients, or other parties.

• Obtain supporting documentation and information needed to appeal denied or underpaid claims.

• Document all collection and claim follow-up activity accurately and timely in the CPSI system.

• Rebill accounts as necessary.

• Maintain appropriate documentation of claim status and follow-up efforts.

Insurance Payment Review and Reimbursement

• Receive and review daily insurance payments and prepare transactions for posting.

• Review explanations of benefits (EOBs) and verify patient information, payer information, dates of service, and payment details.

• Audit insurance payments against applicable contract terms and reimbursement requirements.

• Calculate contractual allowances as necessary.

• Identify non-collectible accounts and forward them to the Revenue Cycle Director for review and appropriate action, including write-off requests, when applicable.

• Assist patients and insurance companies with questions regarding billing procedures, charges, insurance reimbursement, itemized statements, split billings, payments, and other account-related matters.

Accounts Receivable Management

• Monitor and maintain assigned accounts receivable in accordance with departmental goals and procedures.

• Regularly review and follow up on assigned accounts to promote timely resolution and payment.

• Identify and resolve credit balances in a timely manner.

• Generate refund requests for overpayments in accordance with established procedures.

• Maintain accurate documentation of account activity and follow-up.

Other Responsibilities

• Maintain current knowledge of Medicare, Medicaid, commercial insurance, and other third-party billing and reimbursement requirements.

• Stay informed of changes to payer requirements, billing regulations, and applicable HMC policies and procedures.

• Serve as a resource to staff regarding insurance billing and reimbursement questions.

• Assist with training staff on insurance billing processes and procedures as needed.

• Participate in departmental quality improvement activities and process improvement initiatives as assigned.

• Perform other duties as assigned.

Required Qualifications

• High school diploma or equivalent required.

• One to two years of experience in a medical business office, preferably with experience in insurance claim billing and follow-up.

• Working knowledge of Medicare Part A, Medicaid, and commercial insurance billing procedures.

• Knowledge of medical billing and collection procedures.

• Demonstrated working knowledge of computerized medical information management systems.

• Proficiency with Microsoft Office applications, including Word, Excel, and Outlook.

• Strong verbal and written communication skills.

• Excellent telephone communication and customer service skills.

• Strong organizational skills and exceptional attention to detail.

• Ability to analyze billing issues, identify discrepancies, and resolve problems effectively.

• Ability to work independently with general supervision.

• High level of dependability, accuracy, and accountability.

• Ability to effectively communicate and interact with colleagues, hospital staff, patients, physicians and their office staff, and third-party insurance representatives.

• Ability and willingness to work onsite at Hopedale Medical Complex in Hopedale, Illinois.

Preferred Qualifications

• Some college coursework preferred.

• Previous experience with hospital billing and hospital-based services preferred.

• Experience with Medicare, Medicaid, and commercial insurance claim follow-up preferred.

• Experience with UB-04 claims preferred.

• Experience with CPSI, TruBridge, or similar healthcare billing systems preferred.

• Experience working with insurance denials, appeals, contractual allowances, and accounts receivable preferred.

Physical Requirements

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

• Constantly (67–100%): Sitting, talking, hearing, near visual acuity, and repetitive hand/wrist motion associated with computer work, telephone communication, data entry, and documentation.

• Frequently (34–66%): Reaching, handling paperwork, operating office equipment, and moving throughout the assigned work area.

• Occasionally (11–33%): Standing, walking, bending, stooping, and carrying or lifting office materials and supplies.

• Rarely (less than 10%): Pushing or pulling carts, equipment, or other materials associated with office operations.

The employee must be able to communicate effectively, use a computer and telephone for extended periods, review detailed financial and medical information, and perform the essential functions of the position with or without reasonable accommodation.

Work Environment

Work is performed in an office-based healthcare environment within Hopedale Medical Complex. The position involves frequent interaction with patients, insurance representatives, physicians and their office staff, hospital employees, and other healthcare professionals.

The work environment may involve frequent interruptions, changing priorities, deadlines, and confidential patient and financial information. The employee is expected to maintain professionalism, confidentiality, accuracy, and appropriate customer service at all times.

Background Check and Drug Screen

All HMC employees are required to successfully complete applicable federal and state background checks and a pre-employment drug and alcohol screening.

HMC's drug screening process includes testing for substances prohibited under HMC policy, including cannabis (THC), consistent with applicable law and organizational requirements.

Equal Employment Opportunity

Hopedale Medical Complex is an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, sex (including pregnancy, sexual orientation, gender identity, and gender expression), national origin, age, disability, genetic information, veteran status, military status, or any other characteristic protected by applicable federal, state, or local law.

ADA Accommodation

Hopedale Medical Complex provides reasonable accommodations to qualified individuals with disabilities.

Applicants or employees requiring an accommodation during the application, hiring, or employment process should contact the Human Resources Department.

E-Verify

Hopedale Medical Complex participates in E-Verify. In compliance with federal law, individuals hired will be required to verify their identity and authorization to work in the United States and complete the required employment eligibility verification process. E-Verify will be used in accordance with applicable federal requirements.

Disclaimer

This job description is intended to describe the general nature and level of work performed by individuals assigned to this position. It is not intended to be an exhaustive list of all duties, responsibilities, qualifications, or working conditions.

Hopedale Medical Complex reserves the right to modify this job description at any time based on organizational needs.

Compensation details: 24-25 Hourly Wage

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