Children’s Wisconsin is a nationally recognized health system dedicated to the health and well-being of children.
This role reviews and resolves professional billing outpatient service insurance denials and follows up on claims for third-party payers, state programs, and contracted organizations.
Key responsibilities include:
- Contacting guarantors and insurance companies, updating registration, and resubmitting claims to achieve resolution
- Maintaining knowledge of managed care payer contracts and third-party billing guidelines and policies
- Following up on assigned work queues to ensure timely reimbursement
- Analyzing and investigating outpatient service denials and tracking payer-related trends
- Using payer websites to verify insurance information, claim status, payments, denials, and submit online appeals when needed
- Reviewing claim adjustments with management and applying account adjustments when appropriate
- Working with seniors and leads to resolve claim issues
- Maintaining a strong understanding of accounts receivable functions, department policies, procedures, productivity, and quality standards
Requirements & Qualifications
Education
- High school diploma, GED, or HSED required
Experience
- 2+ years of experience in healthcare revenue cycle operations, including comprehension of insurance EOBs
- Pediatric experience preferred
- Prior experience in a large health system with professional billing claims and functions preferred
- Medical billing experience preferred
- Dental billing experience preferred
- Mental/behavioral health billing experience preferred
- Registration experience preferred
- Experience with Epic Resolute preferred
Knowledge and Skills
- Working knowledge of medical terminology, ICD-10, and CPT
- Excellent verbal and written communication skills
- Ability to work independently with minimal supervision
- Strong interpersonal skills to communicate with patients, families, clinic staff, and insurance companies
- Ability to multitask and work effectively in a team environment
- Proficiency with Microsoft Office and general technology tools
Location
Wisconsin, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
3 weeks ago
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