Insurance Specialist II

Position Overview

The Insurance Specialist is responsible for the back-end office processing of insurance claims for Winona Health Services. Responsible for processing claims including but not limited to answering inquiries from insurance companies and patients, rejections, denials, appeals and incorrect payments, follow-up of past due claims, monitor payment/adjustments from contracted insurance payments, and identifying credit/refunds on accounts to keep A/R days within goal range of 35 - 45 days.

Responsible for back-end office processing of insurance claims in a designated section of the alphabet and/or payer split as determined by the Director/Supervisor. May also work with nursing home client billing for Medicare Part A billing requirements. Position is responsible for the back-end office processing of claims which may include one or more of the following; checking eligibility and resubmitting insurance claims through clearinghouse according to insurance, state and/or federal regulations.

• Investigate technical denials on both regular and cycle encounters collaborating with other departments and management to correct and rebill claims.
• Investigate accounts receivable (AR) between 61-90 days in the At-Risk work queue, including checking insurance websites, contacting insurance, and rebilling claims to secure payment.
• Research encounters in the EOB Variance Queue, making necessary corrections on the patient account to ensure proper billing of claims.
• Resubmit late charges promptly to ensure accurate reimbursement for all billed charges.
• Investigate and resolve issues in the Billing Review work queue to ensure claims are processed correctly.
• Work with Health Information Management to review and resolve coding issues utilizing the Coding Review Technical Denial.
• Document precise notes in the financial system for all transactions and correspondence, with timely follow-up as needed.

• Serves as back up to Insurance Specialist I role as needed.
• Monitor insurance websites for medical records requests and process timely through the health information management request process.
• Identify issues within role duties and recommend process improvements to enhance efficiency and accuracy in claim handling.
• Other duties assigned by management.

• Proficient use of Microsoft Teams, Word, Outlook, & Excel
• Strong communication skills both verbal and written, with the ability to handle difficult situations calmly and professionally.
• Strong problem-solving skills and detail-orientated with strong organizational skills.
• Ability to meet deadlines and performance targets
• Advanced time-management and organizational skills to handle multiple priorities with shifting time frames
• Must possess effective customer service oriented communication skills
• Professional and respectful attitude, maintaining confidentiality information in compliance with HIPAA (Health Insurance Portability and Accountability Act) regulations, ensuring patient privacy and data security.

• Previous billing and/or claims management experience is preferred but not required

At Winona Health, we are dedicated to offering a comprehensive and affordable benefits package for our employees and their families. While benefits may vary based on employment classification and job status, the following key benefits are available:

• Health Insurance:
  Options for medical, dental, and vision coverage, as well as mental health support and wellness incentives
• Income Protection:
  Short and long-term disability, plus additional benefits like accident, critical illness, hospital indemnity, legal assistance, and identity protection plans
• Retirement Planning:
  Access to a 403(b) retirement plan with employer contributions once eligibility requirements are met
• Work/Life Balance:
  Flexible scheduling, paid time off, and earned sick time to support personal well-being
• Education & Development:
  Paid training, tuition reimbursement, scholarships, and sponsored seminars to foster both personal and professional growth
• Employee Discounts:
  Special offers with local businesses, including the YMCA and cell phone providers

It is the policy of Winona Health to work with employees in an equitable fashion regarding promotions, transfers, and position reclassifications. Any employee wishing to apply for another available position at Winona Health must submit an application for consideration through the internal application portal. Employees requesting to change positions should have successfully completed at least six (6) months in their current position.

Winona Health is an equal opportunity employer. Winona Health does not refuse to hire, discharge, or discriminate against a person with respect to tenure, compensation, terms, upgrading, conditions, facilities, or privileges of employment because of race, color, creed, religion, sex, age, national origin, marital status, genetic…