Billing Specialist

Claims Processor

Working directly with the insurance company, healthcare provider, and the patient to get a claim processed and paid. You will be required to review and appeal all unpaid and denied claims. This position requires an individual with an extraordinary level of attention to detail and the ability to multi-task. This is a high volume, fast paced and exciting environment.

Essential Duties and Responsibilities

The essential functions include, but are not limited to the following:

• Claims Submission: Ensure all claims are submitted with a goal of zero errors by verifying completeness and accuracy prior to transmission.
• Payment Posting: Accurately post all insurance payments and adjustments by line item.
• Denial Management: Timely follow up on insurance claim denials, exceptions, or exclusions; identify root causes and implement corrective actions.
• Aging Reports: Utilize monthly aging accounts receivable (A/R) reports and work queues to prioritize and follow up on unpaid claims aged over 30 days.
• Documentation: Coordinate medical records requests and complete additional information requests from providers and/or insurance companies.
• Communication: Read and interpret insurance explanation of benefits (EOBs) to determine payment accuracy and patient liability.
• Collaboration: Regularly meet with the Revenue Cycle Supervisor to discuss reimbursement issues, billing obstacles, and process improvements.
• Professional Development: Attend monthly staff meetings and required continuing educational sessions.
• Additional Duties: Perform other duties as assigned to support the Finance department.

Minimum Qualifications (Knowledge, Skills, and Abilities)

Education & Experience:

• High School diploma or equivalent required.
• At least two years' experience in healthcare billing, and alternate payor reimbursement claims processing.
• Knowledge of insurance, managed care, PPO, FQHC billing and Milwaukee County systems are preferred.
• Previous medical terminology and coding experience.

Knowledge, Skills, and Abilities:

• Advanced proficiency in Microsoft Excel (specifically VLOOKUP, Pivot Tables, and advanced formulas) required. Experience with Electronic Medical Record (EMR) and Practice Management (PM) software is a plus.
• Excellent oral, written, and presentation communication skills. Ability to communicate complex billing information clearly to patients, medical staff, and payors.
• Ability to establish and maintain effective working relationships with patients, medical staff, coworkers, and the public.
• Strong analytical skills with the ability to resolve discrepancies and appeal denied claims effectively.

Considerations & Statement

Outreach Community Health Centers requires employees in certain departments to be fully vaccinated against MMR (Measles, Mumps, Rubella), Varicella (Chickenpox), and Influenza.

Outreach Community Health Centers, Inc. is an Equal Opportunity Employer