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High Impact Claims Specialist

3 months ago

Rockford, United States Rosecrance Health Network Full time
Job DescriptionJob Description

Our job is hope.

Join a purpose-driven community of champions.

Position Purpose: The High Impact Claims Specialist will serve as a primary resource to identify high dollar collection issues with our commercial payors, increase revenue and track and trend payor collection issues. This role will work closely with management to support the A/R team’s collection efforts.

Qualifications/Basic Job Requirements:

  • High School diploma or GED
  • Minimum of ten years’ experience in researching and solving high dollar complex insurance claims and denials.
  • Computer proficiency in a Windows environment, knowledge of Microsoft Office products with an emphasis in Excel.
  • Adequate written skills to accurately complete required documentation within the time frames prescribed
  • Excellent organizational and customer service skills

Essential Responsibilities:

  1. Review and process all BC/BS and Commercial high dollar claims (over $10,000) for denials, payor issues and payment trends.
  2. Submit, process and track all appeals for BC/BS and commercial payors. Maintain knowledge of ERISA laws governing employee benefit plans and manage the appeal process for these claims.
  3. Assist A/R staff with complex claim issues they are unable to resolve in a timely manner.
  4. Track and trend all Single Case Agreements. Work closely with Contracting on any SCA payment issues / concerns.
  5. Review payments for BC/BS and commercial payors for rate validation according to our contracts.
  6. Track all denial outcomes for payment, write-offs and transfers to client liability. Identify the root cause for the adjustments to client accounts. Work with management to review adjustment trends and identify potential solutions.
  7. Help maintain integrity of accounts receivable ledger, including aged receivable monitoring on an ongoing basis.
  8. Responsible for maintaining current knowledge of revenue components including benefit plans, contract terms and rates and billing forms and codes.
  9. Check status of claims through use of telephone, websites and/or other means available.
  10. Document adjustments needed to patient accounts.
  11. As needed, participate in phone conference calls with payors.
  12. Pursue collection activities and follow up for balances outside of established norms.
  13. Coordinate collection activities with outside agencies, including court appearances, as needed.
  14. Provide feedback & education management with regards to issues that impact revenue flow.
  15. Provide appropriate documentation and reports designed to assist in fiscal management of the agency.
  16. Serve as a member of the SWAT Team and participate in team meetings.
  17. Serve as a member of the Revenue Cycle Team and participate in all team meetings and activities.
  18. Understand and comply with all of the principles established by the Rosecrance Corporate Compliance Program and Code of Ethics.
  19. Perform all responsibilities in compliance with the mission, vision, values and expectations of Rosecrance.
  20. Deliver exceptional customer service consistently to every customer.
  21. Serve as a role model for other staff, clients and customers and demonstrate positive guest relations in representing Rosecrance.
  22. Assume other related responsibilities as assigned by management.

Schedule: 8-hour shifts

  • Shift: 8:30am - 5:00pm
  • Monday - Friday

Work Location: Rosecrance Health Network - Rockford, IL (must be located in the states we operate: Illinois, Iowa, or Wisconsin)

  • Can be remote

Benefits: Rosecrance values its employees and offers a comprehensive benefits package, including:

  • Salary based on education, experience, and credentials
  • Medical, dental, and vision insurance with multiple plan options to meet your needs
  • 401(k) plan with employer match and discretionary employer contribution
  • Group Life Insurance including LTD and AD&D
  • Tuition assistance and licensure/certification reimbursement
  • Paid Time Off, sick time, bereavement leave
  • Referral program earning up to $1,000 per hire
  • Wellness plan with certain facilities offering an on-site gym
  • Daily pay available through financial wellness provider: UKG Wallet

About Us:

Rosecrance has been at the forefront of providing behavioral health services for over a century. Our mission is to empower individuals and families to overcome substance abuse and mental health challenges through evidence-based therapies and compassionate care. Join us in our mission to foster lasting recovery and transform lives.

We are committed to providing careers that make a difference in the lives of the people we serve and the people we employ. We do this through the work we do, our core mission and values, our employee resources, and especially through our purpose-driven community of opportunity and hope.

Health and Safety:

Committed to upholding a drug-free environment, we prioritize the safety and well-being of both our employees and those under our care. Our zero-tolerance policy extends to all forms of drug use, including marijuana. As a part of our hiring process, candidates are required to undergo an occupational health screening, further ensuring the safety and security of our workplace community.

Equal Employment Opportunity:

Rosecrance is an equal opportunity employer and values diversity in the workplace. We do not discriminate based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, marital status, veteran status, or any other legally protected status. Our hiring decisions are based solely on qualifications, skills, and experience relevant to the requirements of the position.

Rosecrance proudly participates in the AARP Employer Pledge Program and is a partner of MSEP (Military Spouse Employment Partnership).