Claims Submission Rep Lead

3 weeks ago


West Allis, Wisconsin, United States Children's Wisconsin Full time

At Children's Wisconsin, we strive to provide the best possible care for our patients. Our team is dedicated to delivering exceptional service and ensuring that our patients receive the highest quality care. We are seeking a highly skilled and experienced Claims Submission Rep Lead to join our team.

This role will be responsible for supporting the Professional Billing Claims team, working their assigned work queues, and handling complex claims issues. The successful candidate will be the primary resource for training new team members and continuing the training of current staff. They will also assist in the development, coordination, and implementation of new training guides, policies, and procedures within the team.

The ideal candidate will have a strong understanding of payer guidelines, policies, and procedures. They will also possess strong analytical skills and the ability to perform non-complex arithmetic calculations when determining contractual allowances. Additionally, they will have the ability to work independently with minimal supervision and have a working knowledge of account reconciliation and third-party reimbursements from commercial, Medicaid, and Medicare carriers.

We offer a competitive salary and a comprehensive benefits package. If you are a motivated and experienced professional looking for a new challenge, please apply today.

Responsibilities:

  • Support the Professional Billing Claims team
  • Work assigned work queues and handle complex claims issues
  • Train new team members and continue the training of current staff
  • Develop, coordinate, and implement new training guides, policies, and procedures
  • Assist in the development of new training guides, policies, and procedures
  • Work independently with minimal supervision
  • Have a working knowledge of account reconciliation and third-party reimbursements from commercial, Medicaid, and Medicare carriers

Requirements:

  • High School Diploma or Certificate of General Educational Development (GED)/High School Equivalency Diploma (HSED)
  • Three or more years' experience of claims or billing follow-up in healthcare revenue cycle operations, including reimbursement procedures and comprehension of insurance EOBs
  • Strong understanding of payer guidelines, policies, and procedures
  • Strong analytical skills and ability to perform non-complex arithmetic calculations when determining contractual allowances
  • Ability to work independently with minimal supervision
  • Working knowledge of account reconciliation and third-party reimbursements from commercial, Medicaid, and Medicare carriers

Preferred Requirements:

  • An Associate or Bachelor's degree in medical billing, finance, or accounting
  • Prior experience in a large health system working with professional billing claims and functions
  • Medical billing experience
  • Dental billing experience
  • Mental Behavioral Health billing experience
  • Experience in Epic Resolute
  • Experience in Experian products (Contract Manager and ClaimSource)

Certifications/Licenses:



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