Account Resolution Rep

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.

Please follow this link for a closer look at what it’s like to work at Children’s Wisconsin: https://www.instagram.com/lifeatcw/

The Account Resolution Representative is responsible for obtaining fiscal resolution of Government, Medicaid HMO, and Commercial insurance claims. Fiscal resolution is accomplished through following governmental regulations and guidelines & commercial insurance contractual agreements to ensure facility is receiving proper payment for services rendered. The Account Resolution Representative is responsible for investigation of claims denials, insurance processing errors, & open no response claims; in addition to verification accounts are with the correct payer liability and balance. The role also requires follow up on previously actioned on denials, escalation of stalled claims, and identification of payer specific trends to escalate with the Hospital Billing leadership team.

Minimum Job Requirements

Education

High school diploma or equivalent required.

Experience

• Minimum 2 years of experience in claims follow up , HCFAs and/or UB-04’s (preferably in a hospital setting) including insurance reimbursement procedures and comprehension of insurance EOB’s is required.

• General pediatric and/or pediatric subspecialty experience is a plus.

• Prior Epic experience is strongly preferred

Knowledge / Skills / Abilities

• Basic knowledge of medical records and the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

• Basic knowledge and understanding of medical terminology and human anatomy and disease processes.

• Basic knowledge of ICD-10, CPT and HCPCS level II codes.

• Demonstrates accuracy and attention to detail.

• Demonstrated strong problem solving skills including the ability to handle difficult situations.

• Ability to prioritize, organize and meet deadlines.

• Excellent verbal and written communication skills.

• Ability to work independently with minimal supervision.

• Comfortable in both making decisions and acting.

• Ability to multi-task and function effectively in a team environment and maintain effective relationships with coworkers, vendors and payers.

• Advanced computer skills including in using Microsoft Office products, Adobe, electronic mail and/or electronic health information records systems and proficient keyboarding skills.

• Exhibits guiding behaviors that reflect Children’s values and support our mission and vision.

• Remote work opportunity.

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.

Certifications/Licenses: