Insurance Billing Specialist

Position: Insurance Billing Specialist, Full-time
Location: Hopedale

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 Tru Bridge 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 over payments 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…