Claims Submission Rep Lead

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/

This role will be responsible for supporting the Professional Billing Claims team, work their assigned work queues and handle complex claims issues. Will be the primary resource for training of new team members and continued training of current staff. Assist in the development, coordination and implementation of new training guides, policies and procedures within the team. Will be the first point of contact for Claims Submission reps with escalated claims questions and insurance/registration issues. Responsible for Experian Contract Management analysis and assists Manager with fee schedule issue review. May be required to perform Claims Submission Rep duties in addition to their other essential functions.     

Minimum Job Requirements

Education

High School Diploma or Certificate of General Educational Development (GED)/High School Equivalency Diploma (HSED).

Experience

Three or more years’ experience of claims or billing follow up in health care revenue cycle operations including reimbursement procedures and comprehension of insurance EOB’s.

Knowledge/Skills/Abilities

• Strong understanding of payer guidelines, policies and procedures.

• Strong analytical skills and ability to perform noncomplex arithmetic calculations when determining contractual allowances.

• Ability to work independently with minimal supervision.

• Must have working knowledge of account reconciliation and third party reimbursements from Commercial, Medicaid and Medicare Carriers.

• Interpersonal skills necessary to efficiently respond to questions from patients, parents, clinic staff and insurance companies to effectively resolve billing issues.

• Proficient in Microsoft Office applications and technology skills required to perform duties.

• 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.

• Requires the ability to analyze problems relating to the efficiency of the billing and collection functions, as well as to resolve employee relations issues.

• Requires excellent communication skills in order to advise, to counsel, and to direct the work of employees and to effectively interact with employees from other departments in the resolution of problems.

• Working knowledge of CPT-4 and ICD-10 coding, health insurance practices, industry regulations, business office operations, and accounts receivable and financial reporting technology.

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

Physical Requirements and Working Conditions

Remote office environment where there is no reasonable potential for exposure to blood or other high risk body fluids.

Preferred Job Requirements

Education

An Associate or Bachelor’s degree in medical billing, finance or accounting preferred.

Experience

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.

Knowledge / Skills / Abilities

Experience in Epic Resolute preferred.

Experience in Experian products (Contract Manager and ClaimSource) preferred.

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.

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