Claims Submission Rep Lead
6 hours ago
At Children's Wisconsin, we believe kids deserve the best. Our healthcare system is dedicated solely to the health and well-being of children. We provide a wide range of services, including primary care, specialty care, urgent care, emergency care, and more. We are seeking a Claims Submission Rep Lead to join our team.
Job Summary:The Claims Submission Rep Lead will be responsible for supporting the Professional Billing Claims team, working their assigned work queues, and handling complex claims issues. This role will be the primary resource for training of new team members and continued training of current staff. The Claims Submission Rep Lead will also assist in the development, coordination, and implementation of new training guides, policies, and procedures within the team.
Responsibilities:- Support the Professional Billing Claims team in their daily work
- Work assigned work queues and handle complex claims issues
- Train new team members and continue training of current staff
- Assist in the development, coordination, and implementation of new training guides, policies, and procedures within the team
- Be the first point of contact for Claims Submission reps with escalated claims questions and insurance/registration issues
- Responsible for Experian Contract Management analysis and assists Manager with fee schedule issue review
- 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 EOB's
- Strong understanding of payer guidelines, policies, and procedures
- Strong analytical skills and ability to perform noncomplex arithmetic calculations when determining contractual allowances
- Ability to work independently with minimal supervision
- Must have working knowledge of account reconciliation and third-party reimbursements from Commercial, Medicaid, and Medicare Carriers
- Interpersonal skills necessary to efficiently respond to questions from patients, parents, clinic staff, and insurance companies to effectively resolve billing issues
- Proficient in Microsoft Office applications and technology skills required to perform duties
- The ability to multi-task and function effectively in a team environment and maintain effective relationships with coworkers, patients, physicians, management, staff, and other customers
- Requires the ability to analyze problems relating to the efficiency of the billing and collection functions, as well as to resolve employee relations issues
- Requires excellent communication skills in order to advise, to counsel, and to direct the work of employees and to effectively interact with employees from other departments in the resolution of problems
- Working knowledge of CPT-4 and ICD-10 coding, health insurance practices, industry regulations, business office operations, and accounts receivable and financial reporting technology
- Exhibits guiding behaviors that reflect Children's values and support our mission and vision
- 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)
Remote office environment where there is no reasonable potential for exposure to blood or other high-risk body fluids.
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