Insurance Billing Specialist
4 weeks ago
We are seeking a highly skilled Insurance Billing Representative to join our team at Mercy Health System. As a key member of our Revenue Cycle department, you will be responsible for ensuring claims are resolved with third-party payers in a timely and efficient manner.
Key Responsibilities- Claims Resolution: Verify claims are received by the payer and follow up to obtain payment via phone calls, portal, or website use.
- Denial Review: Review claim adjustment reason codes or explanations of benefits received by the payer to determine what reasons for denials records are indicating for appropriate follow-up.
- Appeals and Reconsiderations: Draft and submit appeals or reconsideration forms when applicable based on payer requirements in a format that is logical and relates to the open denial of payment.
- Medical Records: Obtain and send medical records during the appeals process when needed to substantiate medical necessity.
- Billing Accuracy: Review billing forms for both paper submissions and electronic submissions for accuracy.
- Communication: Call patients or payers directly to obtain needed information to resolve an account balance when applicable.
- Trend Identification: Identify trends with payor rejections or denials and escalate these trends to leads/supervisors.
- Computer Systems: Use computer systems/technology to locate claims information to resolve account balances.
- Compliance: Maintain compliance with patient financial services policies and procedures.
- Education: High school diploma or equivalent.
- Experience: Microsoft Excel required and healthcare billing experience preferred.
- Skills: Basic understanding of working in multiple software applications at the same time.
The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is most often required to sit; use hands to finger, handle, or feel and reach with hands and arms. The employee is occasionally required to stand; walk and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, depth perception and ability to adjust focus.
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Insurance Billing Specialist
4 weeks ago
Janesville, Wisconsin, United States Mercy Health System Full timeJob SummaryWe are seeking a highly skilled Insurance Billing Specialist to join our team at Mercy Health System. As a key member of our Revenue Cycle department, you will be responsible for ensuring claims are resolved with third-party payers in a timely and efficient manner.Key Responsibilities:Verify claims are received by the payer and follow up to obtain...
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Administrative Support Specialist
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Behavioral Health Specialist
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Payment Systems Specialist
4 weeks ago
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Accounts Receivable Specialist
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Precertification Specialist
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Traveling Radiology Specialist
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Diagnostic Imaging Specialist
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Mail Processing Specialist
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Radiology Imaging Specialist
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Traveling Radiology Specialist
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Administrative Support Specialist
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Medical Coding Specialist
1 month ago
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Cleaning Specialist
3 weeks ago
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Cabling Installation Specialist
4 weeks ago
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Manufacturing Quality Control Specialist
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Technical Support Specialist
4 weeks ago
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Traveling Radiology Specialist
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Precertification Specialist JMC
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Janesville, Wisconsin, United States Mercy Health System Full timeJob SummaryAs a Precertification Specialist at Mercy Health System, you will play a crucial role in ensuring financial reimbursement for patient care services. Your responsibilities will include verifying insurance benefits, obtaining clinical information for pre-certification, and communicating effectively with various stakeholders. You will also be...
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