Insurance Specialist I

Insurance Specialist I
Business Services
1.0 FTE, 80 Hours a Pay Period
Days, Hours between 7:30 am – 4 pm
Weekends: No
Holidays: No
Telecommute Available: Partial

Position Overview:

The Insurance Specialist I is responsible for managing daily reports, placing and removing billing holds, and monitoring past-due claims. This role ensures the timely and accurate billing of insurance through efficient management of assigned work queues within the patient accounting system. Additionally, they address billing inquiries or direct them to the appropriate staff for resolution as needed.

Essential Duties & Responsibilities:

Reports:

• Generate and analyze Denial Reports to identify ineligible insurance on patient accounts, followed by research, and set up appropriate insurance.
• Runs and addresses Technical Denial Report for encounters that do not populate a work queue. This may involve contacting insurance companies for coding reviews and investigating unpaid claims.
• Generate and analyze multiple claims reports to ensure claims are in proper status and identify claims not progressing in the work queues.

Work Queues/Work Items:

• Review and resolve encounters held in a statement hold queues for Medicaid and Work Compensation claims, ensuring patients are being correctly billed.
• Monitor and resolve issues in the Ready to Bill work queue to ensure claims are processed without delays.  
• Investigate and follow up on past-due claims in the Past Due work queue by checking claim statuses, correcting registration issues, and contacting insurance provider for claims which have not adjudicated timely.

Miscellaneous: 

• Serves as back up to Billing Specialist I and II role as needed.
• Document precise notes in the financial system for all transactions and correspondence, with timely follow-up as needed.
• Identify issues within role duties and recommend process improvements to enhance efficiency and accuracy in claim handling.
• Review, resolve, and distribute incoming insurance correspondence including mail and faxes, to the appropriate staff member.
• Perform additional duties as assigned by management.

Supervisory Responsibilities:

No direct reports

Skills and Experience:

Required:

• High school diploma or equivalent
• Basic computer skills: Microsoft Word, Excel, Outlook, Teams, etc.
• 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 timeframes
• Must possess effective customer service oriented communication skills
• Professional and respectful attitude, maintaining confidential information in compliance with HIPAA (Health Insurance Portability and Accountability Act) regulations, and ensuring patient privacy and data security

Preferred:

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

Summary of Benefits at Winona Health:

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

For more details or specific information, visit our website or contact Human Resources

Internal Applicant Policy:

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. Employees currently in the formal disciplinary process may be required to meet with the Director of Human Resources to determine eligibility to request transfer. The employee’s past performance, experience, training and qualifications will be considered in transfer/hiring decisions. Consideration for transfer or promotion is not a guarantee of transfer or promotion. Employees may be given a chance to interview for a position when they meet the minimum position qualifications.

Disclaimer:

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 information, status with regard to public assistance, membership in a local discrimination commission, sexual orientation, disability, veteran status, or any other prohibited basis of discrimination under applicable local, state, or federal law. Winona Health does not tolerate retaliation against any employee, patient/resident, physician, or other individuals pursuing concerns regarding Civil Rights issues. Winona Health adheres to ALL pertinent governmental policies and legislation including the Civil Rights Act of 1964, Title VII, as amended, and the Minnesota Human Rights Act.