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Senior Claims Resolution Specialist

2 months ago

Rockford, Illinois, United States Rosecrance Full time
Our mission is to provide hope.

Become part of a dedicated community focused on making a difference.

Position Overview: The High-Value Claims Analyst will act as a key resource to identify significant collection challenges with our commercial payors, enhance revenue, and monitor payor collection trends. This position will collaborate closely with management to bolster the A/R team's collection initiatives.

Qualifications/Basic Job Requirements:
  • High School diploma or GED
  • A minimum of ten years' experience in investigating and resolving high-value complex insurance claims and denials.
  • Proficient in a Windows environment, with strong knowledge of Microsoft Office applications, particularly Excel.
  • Strong written communication skills to accurately complete necessary documentation within designated time frames.
  • Exceptional organizational and customer service abilities.
Key Responsibilities:

  1. Examine and manage all BC/BS and commercial high-value claims (exceeding $10,000) for denials, payor issues, and payment patterns.
  2. Submit, process, and monitor all appeals for BC/BS and commercial payors. Maintain awareness of ERISA regulations governing employee benefit plans and oversee the appeal process for these claims.
  3. Support A/R personnel with intricate claim issues that require timely resolution.
  4. Monitor and analyze all Single Case Agreements, collaborating with Contracting on any SCA payment concerns.
  5. Evaluate payments from BC/BS and commercial payors for rate validation in accordance with our contracts.
  6. Track all denial outcomes for payments, write-offs, and transfers to client liability. Identify root causes for adjustments to client accounts and work with management to assess adjustment trends and propose potential solutions.
  7. Assist in maintaining the integrity of the accounts receivable ledger, including ongoing monitoring of aged receivables.
  8. Responsible for staying updated on revenue components, including benefit plans, contract terms, rates, and billing forms and codes.
  9. Check claim statuses using telephone, websites, and other available resources.
  10. Document necessary adjustments to patient accounts.
  11. Participate in conference calls with payors as needed.
  12. Pursue collection activities and follow up on balances that fall outside established norms.
  13. Coordinate collection efforts with external agencies, including court appearances when necessary.
  14. Provide management with feedback and education regarding issues affecting revenue flow.
  15. Prepare appropriate documentation and reports to assist in the fiscal management of the organization.
  16. Contribute as a member of the SWAT Team and participate in team meetings.
  17. Engage as a member of the Revenue Cycle Team, attending all team meetings and activities.
  18. Understand and adhere to all principles established by the Rosecrance Corporate Compliance Program and Code of Ethics.
  19. Perform all duties in alignment with the mission, vision, values, and expectations of Rosecrance.
  20. Deliver outstanding customer service consistently to every client.
  21. Act as a role model for colleagues, clients, and customers, demonstrating positive guest relations in representing Rosecrance.
  22. Assume additional responsibilities as assigned by management.
Schedule: 8-hour shifts
  • Shift: 8:30am - 5:00pm
  • Monday - Friday
Benefits: Rosecrance values its employees and offers a comprehensive benefits package, including:
  • Salary based on education, experience, and credentials
  • Medical, dental, and vision insurance with multiple plan options to meet your needs
  • 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, bereavement leave
  • Referral program earning up to $1,000 per hire
  • Wellness plan with certain facilities offering an on-site gym
  • 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. We are dedicated to providing careers that make a difference in the lives of the people we serve and the people we employ.

Health and Safety:

We are committed to maintaining a drug-free environment, prioritizing the safety and well-being of both our employees and those under our care. Our zero-tolerance policy extends to all forms of drug use. As part of our hiring process, candidates are required to undergo an occupational health screening, ensuring the safety and security of our workplace community.

Equal Employment Opportunity:

Rosecrance is an equal opportunity employer and values diversity in the workplace. We do not discriminate based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, marital status, veteran status, or any other legally protected status. Our hiring decisions are based solely on qualifications, skills, and experience relevant to the requirements of the position.