Insurance Claims Specialist

6 days 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 Responsibilities:

• Review and process high-dollar claims for denials, payor issues, and payment trends
• Submit, process, and track appeals for commercial payors
• Maintain knowledge of ERISA laws governing employee benefit plans and manage the appeal process
• Assist A/R staff with complex claim issues
• Track and trend Single Case Agreements and work closely with Contracting on payment issues
• Review payments for rate validation and track denial outcomes
• Maintain integrity of accounts receivable ledger and provide feedback to management on revenue flow

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 and knowledge of Microsoft Office products
• Excellent organizational and customer service skills

Benefits:

Rosecrance offers a comprehensive benefits package, including salary based on education, experience, and credentials, medical, dental, and vision insurance, 401(k) plan with employer match, and tuition assistance and licensure/certification reimbursement.

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.

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