Pay range: $22.30 - $30.11 per hour, based on experience.

In addition, this role is eligible to work remotely from an approved state by St. Charles (please refer to the list). If you do not reside in an approved listed state (or do not plan to relocate to an approved listed state) we request, you do not apply for this particular position.

Approved states by St. Charles: Oregon, Arizona, Arkansas, Florida, Idaho, Missouri, Montana, Nevada, New Mexico, North Carolina, Oklahoma, Tennessee, Utah, and Wisconsin.

About St. Charles Health System:

St. Charles Health System is a leading healthcare provider in Central Oregon, offering a comprehensive range of services to meet the needs of our community. We are committed to providing high-quality, compassionate care to all patients, regardless of their ability to pay. Our values of compassion, excellence, integrity, teamwork, and stewardship guide our work and shape our culture.

What We Offer:

Competitive Salary

Comprehensive benefits including Medical, Dental, Vision for you and your immediate family

403b with up to 6% match on Retirement Contributions

Generous Earned Time Off

Growth Opportunities within Healthcare

ST. CHARLES HEALTH SYSTEM

JOB DESCRIPTION

TITLE:                                      Insurance Biller 2

REPORTS TO POSITION:         Claims Supervisor

DEPARTMENT:                        Single Billing Office

DATE LAST REVIEWED:          August 2024  

OUR VISION:                Creating America’s healthiest community, together.

OUR MISSION:             In the spirit of love and compassion, better health, better care, better value

OUR VALUES:              Accountability, Caring and Teamwork

DEPARTMENTAL SUMMARY: The Single Billing Office (SBO) at St. Charles Health System (SCHS) provides revenue cycle services to our multi-hospital and medical group organization focusing on billing, collecting, and posting revenue. The goal of the SBO is to deliver a delightful, transparent, and seamless experience to patients and customers that captures and collects the revenue earned by SCHS in a quality, efficient and timely manner. Services include but are not limited to: billing insurance claims, posting insurance and patient payments, resolving insurance denials, collecting unpaid insurance claims, maintaining payer contracts in the electronic health record (EHR), resolving under and over payments, identifying and resolving payer issues, processing refunds, processing financial assistance applications, billing patients, resolving patient accounts including patient questions, and vendor management: lockbox, clearinghouse, early out, collection agencies.

POSITION OVERVIEW: The Insurance Biller 2 position is an intermediate position responsible for intermediate billing tasks including resolving claim edits, addressing billing related do not bill (DNB) and stop bills, resolving payer rejections (277 or DDE), and splitting or combining claims. The level 2 position requires an intermediate understanding of payer reimbursement methodologies, standard billing guidelines, and EHR functionality. This position may work with internal and external stakeholders including SBO teams, other St Charles departments, and community entities if appropriate.

This position does not directly supervise any other caregivers.

ESSENTIAL FUNCTIONS AND DUTIES:

Bill facility (HB) and professional (PB) claims to insurance payers or other entities per SBO standard work.

Submit basic itemized statements, medical records, and other required information to insurance payors via clearinghouse, mail, or other electronic means.

Verify and update insurance coverage as applicable using EHR tools, payer websites, or via phone calls to payers.

Resolve complex billing related claim edits within EHR, DNBs and Stop Bills.

Resolve complex payer rejections including Medicare return to provider (RTP) and clearinghouse rejections (277’s).

Split and combine claims as required by payer.

Obtain ICN’s for pending corrected claims using EHR tools, payer websites, other resources (clearinghouse or lockbox), or via phone call to payers.

Apply intermediate knowledge of current reimbursement methodologies as defined by department complexity matrix.

Apply intermediate knowledge of billing requirements as defined by department complexity matrix.

Process late charges using the late charge functionality.

Generate and release medical records.

Split charges to a separate HAR or liability bucket and combine charges to a single HAR as needed.

Submit corrected claims.

Update claim information including ICN, authorizations, billing information, or other required claim elements.

Review and resolve billing correspondence.

Enter clear and concise documentation in the patient health information system.

Obtain and maintain knowledge of current billing requirements and any changes via payer newsletters, payer workshops, payer webinars, or other applicable source.

Attend applicable meetings including payer meetings and educational opportunities as appropriate.

Support the vision, mission, and values of the organization in all respects.

Support Lean principles of continuous improvement with energy and enthusiasm, functioning as a champion of change.

Provide and maintain a safe environment for caregivers, patients, and guests.

Conduct all activities with the highest standards of professionalism and confidentiality. Comply with all applicable laws, regulations, policies, and procedures, supporting the organization’s corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violation of applicable rules, and cooperating fully with all organizational investigations and proceedings.

Deliver customer service and/or patient care in a manner that promotes goodwill, is timely, efficient, and accurate.

May perform additional duties of similar complexity within the organization, as required or assigned.

EDUCATION

                   

Required: High school graduate or GED           

Preferred: Course work in medical terminology or other revenue cycle functions such as RHIT or medical coding.

LICENSURE/CERTIFICATION/REGISTRATION

Required: N/A 

Preferred: Certified Healthcare Financial Professional (CHFP), Certified Revenue Cycle Representative (CRCR), Certified Specialist Account and Finance (CSAF), Certified Specialist Payment and Reimbursement (CSPR), Registered Health Information Technician (RHIT), Certified Coding Specialist Physician Based (CCS-P), Certified Coding Associate (CCA), Certified Coding Specialist (CCS), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), Certified Professional Coder (CPC), Certified Professional Biller (CPB). 

EXPERIENCE

Required:  Three years of healthcare experience, of which two years must have been in billing or equivalent role. One year of healthcare experience may be substituted with an applicable certification (RHIT, Medical coding, etc.). One year of Epic experience.

Preferred: Two years of Epic experience.

PERSONAL PROTECTIVE EQUIPMENT

Must be able to wear appropriate Personal Protective Equipment (PPE) required to perform the job safely.

ADDITIONAL POSITION INFORMATION: 

Knowledge of standard billing requirements.

Intermediate knowledge of payer reimbursement methodologies.

Basic skills in Microsoft Office applications including Excel, One Note, Outlook, and Word.

Problem solving and research skills.

Strong communication skills including ability to articulate complex technical issues impacting billing.

PHYSICAL REQUIREMENTS:

Continually (75% or more): Sitting, keyboard operation, use of clear and audible speaking voice and the ability to hear normal speech level.

Frequently (50%): Standing, lifting 1-10 pounds, grasping/squeezing.

Occasionally (25%): Bending, reaching overhead, carrying/pushing or pulling 1-10 pounds.

Rarely (10%):  Walking, stooping/kneeling/crouching, climbing stairs.

Never (0%):  Climbing ladder/step-stool, lifting/carrying/pushing or pulling 11-50 pounds, operation of a motor vehicle, ability to hear whispered speech level.

Exposure to Elemental Factors

Never (0%):  Heat, cold, wet/slippery area, noise, dust, vibration, chemical solution, uneven surface.

Blood-Borne Pathogen (BBP) Exposure Category

No Risk for Exposure to BBP

.

Schedule Weekly Hours:

40

Caregiver Type:

Regular

Shift:

Is Exempt Position?

No

Job Family:

INSURANCE BILLER

Scheduled Days of the Week:

Monday-Friday

Shift Start & End Time:

40 hours