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High Impact Claims Specialist

2 months ago

Rockford, Illinois, United States Rosecrance Full time
Job Summary

We are seeking a highly skilled High Impact Claims Specialist to join our team at Rosecrance. As a key member of our revenue cycle team, you will play a critical role in identifying and resolving high-dollar collection issues with commercial payors, increasing revenue, and tracking and trending payor collection issues.

Key Responsibilities
  • Review and process high-dollar claims for denials, payor issues, and payment trends.
  • Submit, process, and track appeals for BC/BS and commercial payors, maintaining knowledge of ERISA laws governing employee benefit plans.
  • Assist A/R staff with complex claim issues and track and trend Single Case Agreements.
  • Review payments for rate validation and track denial outcomes for payment, write-offs, and transfers to client liability.
  • Maintain integrity of accounts receivable ledger and monitor aged receivable trends.
  • Stay up-to-date on revenue components, including benefit plans, contract terms, and rates.
  • Communicate with payors, document adjustments, and pursue collection activities.
Requirements
  • High School diploma or GED.
  • Minimum of ten years' experience in researching and solving high-dollar complex insurance claims and denials.
  • Computer proficiency in a Windows environment and knowledge of Microsoft Office products, with an emphasis on Excel.
  • Adequate written skills to complete required documentation within prescribed timeframes.
  • Excellent organizational and customer service skills.
Benefits
  • Salary based on education, experience, and credentials.
  • Medical, dental, and vision insurance with multiple plan options.
  • 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, and bereavement leave.
  • Referral program earning up to $1,000 per hire.
  • Wellness plan with on-site gym facilities.
  • Daily pay available through financial wellness provider: UKG Wallet.
About Us

Rosecrance has been a leader in 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 those we serve and those we employ. We do this through our work, core mission and values, employee resources, and our purpose-driven community of opportunity and hope.