Insurance Claims Specialist

3 weeks ago

Rockford, United States Rosecrance Full time
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
  • Extensive 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).

  • Insurance Claims Specialist

    2 weeks ago

    Rockford, Illinois, United States Rosecrance Full time

    Job Summary:As a High Impact Claims Specialist at Rosecrance, you will play a critical role in identifying and resolving high-dollar collection issues with commercial payors. This position requires a strong analytical mind, excellent communication skills, and the ability to work closely with management to support the A/R team's collection efforts.Key...

  • Benefits Account Manager

    2 weeks ago

    Rockford, Illinois, United States Superior Insurance Partners LLC Full time

    Job OverviewSuperior Insurance Partners LLC is a rapidly growing insurance brokerage platform focused on providing commercial lines, personal lines, and employee benefit solutions to companies and individuals.

  • Insurance Commercial Lines Business Development Specialist

    4 days ago

    Rockford, Illinois, United States GPAC Full time

    About the RoleWe are seeking a highly skilled and experienced Commercial Lines Account Manager to join our dynamic team at GPAC. As a key member of our insurance team, you will be responsible for managing a portfolio of commercial lines accounts and providing exceptional client service.Key Responsibilities:Manage a book of commercial lines accounts, serving...

  • Revenue Growth Specialist

    2 weeks ago

    Rockford, Illinois, United States Rosecrance Health Network Full time

    We are seeking a skilled Revenue Growth Specialist to join our team at Rosecrance Health Network. This role is focused on identifying high dollar collection issues with commercial payors, increasing revenue, and tracking payor collection issues.About the RoleThis position requires strong research and problem-solving skills, as well as computer proficiency...

  • Hospital Coding Specialist

    2 weeks ago

    Rockford, United States Mercy Health System Full time

    Overview Conducts thorough review of medical record documentation and assigns codes for diagnoses and procedures utilizing the ICD-10 CM, ICD-10 PCS, CPT and HCPCS coding classification systems. Abstracts required data elements needed for reimbursement and reporting purposes. Follows workflows related to severity of illness, risk of mortality, hospital...

  • Hospital Coding Specialist

    3 weeks ago

    Rockford, United States Mercy Health System Full time

    Overview Conducts thorough review of medical record documentation and assigns codes for diagnoses and procedures utilizing the ICD-10 CM, ICD-10 PCS, CPT and HCPCS coding classification systems. Abstracts required data elements needed for reimbursement and reporting purposes. Follows workflows related to severity of illness, risk of mortality, hospital...

  • Employee Benefits Account Manager

    3 weeks ago

    Rockford, United States Superior Insurance Partners LLC Full time

    Superior Insurance Partners is a rapidly growing insurance brokerage platform, focused primarily on providing commercial lines, personal lines, and employee benefit solutions to companies and individuals. Superior acquires and partners with leading independent insurance agencies primarily in the Midwest and Eastern US. The company's mission is to improve the...

  • Employee Benefits Account Manager

    1 week ago

    Rockford, United States Superior Insurance Partners LLC Full time

    Superior Insurance Partners is a rapidly growing insurance brokerage platform, focused primarily on providing commercial lines, personal lines, and employee benefit solutions to companies and individuals. Superior acquires and partners with leading independent insurance agencies primarily in the Midwest and Eastern US. The company's mission is to improve the...

  • Insurance Account Manager- Commercial Lines

    2 weeks ago

    Rockford, United States GPAC Full time

    Job Posting: Insurance Commercial Lines Account ManagerAbout Us: We pride ourselves on delivering exceptional insurance solutions and unparalleled customer service. As a leader in the industry, we are committed to fostering a dynamic work environment where our team can thrive and grow. We are currently seeking a talented and experienced Commercial Lines...

  • Medical Coding Specialist

    3 weeks ago

    Rockford, United States Ortho Illinois Full time

    The Medical Coding Specialist is responsible for daily charge capture for all assigned providers and/or ancillary services ensuring correct coding guidelines are followed.Primary Duties and Responsibilities:• Retrieves relevant information from medical records for appropriate billing using current CPT and ICD 10 code guidelines• Reviews daily charge...

  • Medical Coding Specialist

    1 week ago

    Rockford, United States Ortho Illinois Full time

    The Medical Coding Specialist is responsible for daily charge capture for all assigned providers and/or ancillary services ensuring correct coding guidelines are followed.Primary Duties and Responsibilities:• Retrieves relevant information from medical records for appropriate billing using current CPT and ICD 10 code guidelines• Reviews daily charge...

  • GPAC | Insurance Account Manager- Commercial Lines IL | rockford, il

    3 weeks ago

    rockford, United States GPAC Full time

    Insurance Commercial Lines Account ManagerAbout Us: We pride ourselves on delivering exceptional insurance solutions and unparalleled customer service. As a leader in the industry, we are committed to fostering a dynamic work environment where our team can thrive and grow. We are currently seeking a talented and experienced Commercial Lines Account Manager...

  • Medical Coding Specialist

    3 weeks ago

    Rockford, United States Ortho Illinois Full time

    Job Purpose:The Medical Coding Specialist is responsible for daily charge capture for all assigned providers and/or ancillary services ensuring correct coding guidelines are followed.Primary Duties and Responsibilities:• Retrieves relevant information from medical records for appropriate billing using current CPT and ICD 10 code guidelines• Reviews daily...

  • Patient Access Specialist

    5 months ago

    Rockford, United States Mercy Health Full time

    Overview: Patient Access Specialist, Days, 80 Hrs / 2 wks Location: Rockton Ave Campus; Rockford, IL. Hybrid schedule opportunities available after probationary period. Responsible for correctly prioritizing and completing all steps of the scheduling, referral management, authorization, verification and registration process prior to patients receiving...

  • Diagnostic Imaging Specialist

    2 days ago

    Rockford, Illinois, United States LRS Healthcare - Imaging Full time

    Job Title: Diagnostic Imaging SpecialistWe are seeking a skilled Diagnostic Imaging Specialist to join our team in Rockford, Illinois. As a Diagnostic Imaging Specialist, you will be responsible for operating CT scanners and other imaging equipment to produce high-quality diagnostic images.This is a 12-week travel assignment with a 36-hour workweek, offering...

  • Career Opportunities: Insurance Benefits Specialist

    2 weeks ago

    Rockford, Illinois, United States AO Globe Life - Mike Gatto Full time

    About AO Globe LifeWe are a dynamic organization dedicated to providing families with critical insurance solutions. Our team is passionate about delivering exceptional customer experiences and making a positive impact on people's lives.Compensation PackageWe offer a competitive salary, estimated at $60,000 - $80,000 per year, depending on experience and...

  • Commercial Surety Insurance Bond Specialist

    2 weeks ago

    Rockford, United States Diedre Moire Corp. Full time

    Job TitleContract Surety UnderwritingAbout UsDiedre Moire Corp. is a leading company in the field of commercial surety insurance, and we are seeking an experienced Contract Surety Underwriting professional to join our team.Salary InformationWe offer a competitive salary range of $85,000 - $115,000 per year, depending on experience.Job DescriptionA Contract...

  • Travel Imaging Specialist

    3 weeks ago

    Rockford, Illinois, United States Focus Staff Full time

    About the Job">Focus Staff is seeking a highly skilled Travel Imaging Specialist to join their team for a travel contract in Rockford, Illinois.">Job Overview">">This 13-week contract requires a specialist with at least 1 year of experience in CT and X-Ray technology.">The ideal candidate will have strong technical skills, excellent communication abilities,...

  • Medical Travel RN Specialist

    2 weeks ago

    Rockford, Illinois, United States Anders Group Full time

    Exciting Opportunity for a Medical Travel RN SpecialistWe are seeking a skilled and dedicated Medical Travel RN Specialist to join our team at Anders Group.This is a 13-week assignment in Rockford, Illinois, with a shift schedule of 12 hours per night and 36 hours per week.The ideal candidate will have strong clinical skills and excellent communication...

  • Diagnostic Imaging Specialist

    7 days ago

    Rockford, Illinois, United States Voca Full time

    About the JobWe are seeking a skilled Diagnostic Imaging Specialist to join our team in Rockford, Illinois. This 13-week assignment offers a great opportunity to gain new clinical skills and experience.As a Diagnostic Imaging Specialist, you will be responsible for operating MRI equipment, ensuring high-quality images, and providing excellent patient...