Insurance Billing Specialist

Overview

Crossing Rivers Health is seeking an Insurance Billing Specialist. This full-time position (80 hours per pay period) involves accurately and promptly reviewing and updating claims requiring manual intervention prior to submission, submitting claims to insurance carriers, following up on unpaid claims, and handling denied claims to resolve errors or provide information for disputing or resubmitting. The role requires routine problem solving and handles inquiries from both insurance carriers and patients, with a goal of account resolution.

Our core values—Joy, Unity, Integrity, Compassion, Excellence—guide actions and services provided.

• Reviews, edits, and corrects claims, as necessary, checking for accuracy and readiness of claims to be submitted through the electronic health record (EPIC).
• Prepares and submits claims to insurance carriers and intermediaries (releasing electronic claims, printing paper claims, and/or secondary claims as required per individual payer).
• Works with various departments to ensure that held claims are released to the payer within timely filing limits.
• Performs follow-up procedures, inquiring on the status of unpaid claims via phone calls or payer portals to ensure timely payment of insurance claims.
• Responds to routine patient and insurance company inquiries and problems.
• Researches denials/non-covered charges and re-submits or appeals, as necessary.
• Reviews late charges for re-billing or adjustment of claims, as necessary.
• Reviews insurance eligibility or coverage changes to ensure accuracy of information, resolve any outstanding issues, and rebill claims when necessary.
• Updates necessary changes to patient demographics and/or insurance information.
• Reviews accounts with insurance credit balances and determines if a refund or other action is necessary to settle the account.
• Accommodates patient requests and inquiries promptly and courteously, answering incoming calls to the Business Office, educating patients on their financial responsibilities, accepting payments, and setting up payment plans.
• Performs other duties as deemed necessary for the continued viability and success of the department and organization as a whole.
• Other job duties and responsibilities as assigned to effectively meet the needs of the patients, the department, and the organization as a whole.

• Accountability – Ability to accept responsibility and account for one’s actions.
• Communication – Ability to convey ideas effectively and listen to others.
• Customer Oriented – Ability to take care of customers’ needs while following company procedures.
• Detail Oriented – Ability to pay attention to detail.
• Organized – Ability to perform tasks systematically.
• Ethical – Ability to demonstrate conduct conforming to values and standards.
• Accuracy – Ability to perform work accurately and thoroughly.
• Reliability – The trait of being dependable and trustworthy.
• Research Skills – Ability to design and conduct systematic investigations.

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

• High School Graduate or General Education Degree (GED):
  Required
• Associate’s Degree (two year college or technical school) Preferred, Field of Study:
  Business Related

• 1-2 years of healthcare billing experience preferred
• 1-2 years of EPIC experience preferred

• Microsoft Office proficiency