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Billing Insurance Claims Specialist

2 months ago

Milwaukee, Wisconsin, United States Sixteenth Street Community Health Center Full time
Job Summary

We are seeking a highly skilled and detail-oriented Billing Insurance Claims Specialist to join our team at Sixteenth Street Community Health Center. As a key member of our revenue cycle team, you will be responsible for prebilling, billing, and follow-up activities on open insurance claims, ensuring timely and accurate communication with internal teams and external customers.

Key Responsibilities
  • Prebilling and billing of insurance claims, exercising revenue cycle knowledge and expertise
  • Follow-up activity on open insurance claims, including obtaining necessary documentation and communicating with internal teams and external customers
  • Timely and accurate communication with internal teams and external customers, including third-party payors, auditors, and other entities
  • Identification and reporting of patterns and trends related to coding and compliance, contracting, claim form edits/errors, and credentialing
  • Obtaining and maintaining knowledge of insurance payer updates and changes, and assisting management with recommendations for implementation of edits/alerts
  • Accurate entry and/or update of patient/insurance information into the patient accounting system
  • Appeals of claims to ensure contracted amounts are received from third-party payors
  • Compliance with KPIs for assigned payers, within standards established by department and insurance guidelines
  • Compilation of information for referral of accounts to internal/external partners as needed
  • Clear and accurate documentation of all activity relating to billing and follow-up efforts for each account, utilizing established guidelines
Requirements
  • High School Diploma or General Education Degree (GED)
  • Typically requires 1 year of related experience in a medical/billing reimbursement environment or an equivalent combination of education and experience
  • Experience in EPIC preferred
  • Ability to work independently with limited supervision, and perform within departmental guidelines for productivity and quality standards
  • Accountable and evaluated to organization behaviors of excellence
  • Basic keyboarding proficiency, and ability to operate computer and software systems in use at Sixteenth Street Community Health Center
  • Ability to read, write, speak, and understand English proficiently
  • Ability to read and interpret documents such as an explanation of benefits (EOB), operating instructions, and procedure manuals
Preferred Qualifications
  • Knowledge of medical terminology, coding, terminology (CPT, ICD-10, HCPC), and insurance/reimbursement practices
  • Ability to communicate well with people to obtain basic information (via telephone or in-person)