Insurance Billing Associate (hybrid), full time, days

ESSENTIAL FUNCTIONS 

Billing 

• Prepare, submit, and manage electronic and paper insurance claims to third-party payers, ensuring accuracy and compliance with payer-specific requirements and regulatory guidelines. 

• Analyze and resolve claim rejections daily within the hospitals clearinghouse system to ensure timely claim submission, reduce denial risk and support optimal reimbursement. 

• Analyze and resolve claim edits daily within the Hospital’s EHR system to support a high first-pass clean claim rate and minimize denials. 

• Thoroughly analyze denied claims and resubmit corrected claims with updated charges, coding revisions, demographic corrections, and all required information to reduce denials and maximize reimbursement. Perform additional billing-related tasks as needed, including special rebilling initiatives/projects. 

Claim Resolution / Denials 

• Monitor claim processing status and proactively follow up with payers if processing has not been initiated/received within 45 days; resubmit or submit new claims when necessary. 

• Investigate and resolve payer claim denials within required timeframes, identify root causes, and implement corrective actions (including in the clearinghouse application when applicable) to prevent recurrence. 

• Review and address both incoming patient and insurance correspondence (mail/email) within one business day, ensuring timely communication and follow-up. 

• Analyze and resolve claim edits daily within the Hospital’s EHR system to support a high first-pass clean claim rate and minimize denials. 

• Manage payer relationships and reimbursement activities by communicating with payers through phone and secure portals, participating in payer meetings, monitoring policy changes, and preparing and submitting untimely appeals. 

Reporting / Documentation 

• Maintain accurate, thorough documentation of billing activity (including insurance phone calls and actions taken on each encounter) with clear, concise, and specific detail in the billing system. 

• Adhere to departmental and Hospital performance metrics including A/R goals, productivity benchmarks, and quality audit requirements. 

Compliance and Communication 

• Maintain working knowledge of federal/state regulations and payer-specific requirements (including Medicare, Medicaid, and fiscal intermediaries) to support compliant claims submission. 

• Investigate and analyze outstanding debit and credit balances within designated timeframes; collaborate with stakeholders to determine appropriate resolutions. 

• Manage communications effectively (email, telephone, instant messaging) with payers and internal departments to resolve billing inquiries promptly. 

• Maintain strict compliance with HIPAA guidelines to safeguard patient information and confidentiality. 

• Attend mandatory internal/external training and education to remain current on best practices, coding changes, and regulatory updates.