[Hiring] Account Resolution Rep I PB @Children's Wisconsin

Role Description

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.

• 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.

Qualifications

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

Requirements

• 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.

Company Description