Insurance Billing Specialist FTE, Day Shift

Insurance Billing Specialist (FT- 1.0 FTE, Day Shift)

Position Summary:

The Insurance Billing Specialist’s main focus is to obtain maximum and appropriate reimbursement for Bozeman Health and all related entities, hospital (HB) and/or professional (PB) claims from third party payers. Supports the timely development and accurate submission of claims to third party payers to include insurance follow‑up related to no response, returned claims, denied claims, or claim edits preventing claim submission, submitting corrected or replacement claims, and combining hospital accounts in accordance with payer billing policies.

Monitors, resolves or escalates payer denials, returned claims, claim edits, correspondence and reports payer claim processing behavior to assist with identifying systemic issues that may require process improvement to strengthen the health of the Revenue Cycle as well as escalating identified concerns to the HB or PB Supervisor. Collaborates and coordinates with other Revenue Cycle functions or departments to resolve DNBs, claim edits, denials that are preventing timely claim submission or appropriate reimbursement.

Prioritizes and completes accounts routed to billing WQs to reduce accounts receivable days and escalates high‑dollar accounts or systemic issues to either the HB or PB Billing supervisor for resolution.

Required

• High School Diploma or Equivalent
• One year of office experience

Preferred

• Completion of program in medical billing degree or certification program
• Two years of healthcare clinic/hospital billing experience

• Submits timely and accurate claims to primary, secondary, and tertiary insurances for both electronic and paper submission
• Follows up on applicable No Response WQs and Rejected Claims WQs through phone contact or written correspondence to ensure that no account reaches 180 days old from discharge date and still due by insurance, regardless of dollar amount
• Reviews accounts by verifying that reimbursement amounts are appropriate, coordination of refunds, if appropriate, and submitting adjustments for approval when necessary, routes claims for appeal, resubmits claims, or moves balances from insurance responsibility to patient responsibility when appropriate
• Ensures that claims have appropriate information on them for submission to insurance companies or agencies by reviewing claim edit WQs and other prebilling insurance WQs and escalates systemic issues identified to supervisor
• Assists Customer Service with claim processing questions
• Identifies and escalates concerns regarding claim processing to Billing Supervisor

• Demonstrates sound judgment, patience, and maintains a professional demeanor at all times
• Exercises tact, discretion, sensitivity, and maintains confidentiality
• Performs essential job functions successfully in a busy and stressful environment
• Learns current and new computer applications and office equipment utilized at Bozeman Health
• Strong interpersonal, verbal, and written communication skills
• Analyzes, organizes, and prioritizes work while meeting multiple deadlines
• Works varied shifts as scheduled and/or needed

• This role requires regular and sustained attendance.
• The position may necessitate working beyond a standard 40‑hour workweek, including weekends and after‑hours shifts.
• On‑call work may be required to respond promptly to organizational, patient, or employee needs.

• Lifting (Rarely – 30 pounds):
  Exerting force occasionally and/or using a negligible amount of force to lift, carry, push, pull, or otherwise move objects or people.
• Sit (Continuously):
  Maintaining a sitting posture for extended periods may include adjusting body position to prevent discomfort or strain.
• Stand (Occasionally):
  Maintaining a standing posture for extended periods may include adjusting body position to prevent discomfort or strain.
• Walk (Occasionally):
  Walking and moving around within the work area requires good balance and coordination.
• Climb (Rarely):
  Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like using feet and legs; may also use hands…