Account Resolution Rep I PB-Remote

Children's Wisconsin Professional Billing Specialist

At Children's Wisconsin, we believe kids deserve the best.

Children's Wisconsin is a nationally recognized health system dedicated solely to the health and well-being of children. We provide primary care, specialty care, urgent care, emergency care, community health services, foster and adoption services, child and family counseling, child advocacy services and family resource centers. Our reputation draws patients and families from around the country.

We offer a wide variety of rewarding career opportunities and are seeking individuals dedicated to helping us achieve our vision of the healthiest kids in the country. If you want to work for an organization that makes a difference for children and families, and encourages you to be at your best every day, please apply today.

Job Summary: Reviews and resolves Professional Billing outpatient service insurance denials as well as following up on claims timely for third party payers, state programs and contracted organizations for Children's Wisconsin. Essential Functions:

• Performs various follow-up actions including contacting guarantors, insurance companies, updating Registration, resubmitting claims in order to achieve claim resolution.
• Maintains current knowledge of managed care payer contracts and third party payer billing guidelines and policies for assigned payers (Commercial/Government).
• Follows-up on assigned work queues to ensure timely reimbursement based on assigned payer timely filing guidelines.
• Analyzes and investigates outpatient service denials, identify and/or track trends associated to payers. Keeping leads and management appraised of identified issues having an impact on reimbursement.
• Utilizes payer websites to verify patient insurance information, claim status/payments/denials and/or to appeal online as necessary to obtain proper payment on claims.
• Reviews and recommends adjustments of claims to management. Applies account adjustments when appropriate.
• Works with Seniors and Leads to resolve claim issues.
• Maintains a thorough understanding of A/R functions, department policies and procedures. Maintains productivity and quality standards as set by management.

Education:

• High School graduate or Certificate of General Educational Development (GED) or High School Equivalency Diploma (HSED) Required or

Experience:

• 2+ years experience in health care revenue cycle operations including comprehension of insurance EOB's Required
• Pediatric experience Preferred
• Prior experience in a large health system working 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 in Epic Resolute Preferred

Knowledge, Skills and Abilities:

• Working knowledge of medical terminology, ICD-10 and CPT.
• Excellent verbal and written communication skills.
• Ability to work independently with minimal supervision.
• Interpersonal skills necessary to efficiently respond to questions from patients, parents, clinic staff and insurance companies to effectively resolve billing issues.
• The ability to multi-task and function effectively in a team environment and maintain effective relationships with coworkers, patients, physicians, management staff and other customers.
• Proficient in Microsoft Office applications and technology skills required to perform duties.

Required for All Jobs:

• This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that may be requested in the job.
• Employment is at-will. This document does not create an employment contract, implied or otherwise.

Children's Wisconsin is an equal opportunity / affirmative action employer. We are committed to creating a diverse and inclusive environment for all employees. We treat everyone with dignity, respect, and fairness. We do not discriminate against any person on the basis of race, color, religion, sex, gender, gender identity and/or expression, sexual orientation, national origin, age, disability, veteran status, or any other status or condition protected by the law.