Account Resolution Rep II PB

Children's Hospital and Health System • West Allis, WI

2d

About The Position

Children’s Wisconsin is a nationally recognized health system dedicated to children’s health and well-being. The Account Resolution Rep II researches and resolves complex Professional Billing service insurance denials and works to ensure claims receive maximum reimbursement from third-party payers, state programs, and contracted organizations. The role follows up on claims, investigates denial issues, coordinates resolutions, and maintains compliance with payer requirements while meeting management-set productivity and quality standards.

Requirements

• High school graduate, GED, or HSED.
• At least 2 years of experience in healthcare revenue-cycle claims follow-up, including reimbursement procedures and understanding insurance EOBs.
• Working knowledge of medical terminology, ICD-10, CPT, and HCPCS Level II codes.
• Strong understanding of payer guidelines, policies, and procedures.
• Excellent verbal and written communication skills.
• Ability to work independently with minimal supervision.
• Strong analytical skills and ability to perform noncomplex arithmetic calculations when determining contractual allowances.
• Working knowledge of account reconciliation and third-party reimbursements from commercial, Medicaid, and Medicare carriers.
• Interpersonal skills to respond efficiently to questions from patients, parents, clinic staff, and insurance companies and resolve billing issues.
• Ability to multitask, work effectively in a team, and maintain effective relationships with coworkers, patients, physicians, management, staff, and other customers.
• Proficiency in Microsoft Office applications and the technology skills needed to perform the duties.

Nice To Haves

• Prior experience in a hospital system working with professional billing claims and functions.
• Inpatient and surgical medical billing experience.
• Mental and behavioral health billing experience.
• Experience with Epic Resolute.

Responsibilities

• Contact guarantors and insurance companies; update registration; correct and resubmit claims; and file appeals to resolve claims.
• Maintain current knowledge of managed care payer contracts and third-party billing guidelines and policies for assigned commercial and government payers.
• Follow up on assigned work queues according to payer timely-filing guidelines to ensure proper reimbursement.
• Identify CPT-4 and ICD-10 coding issues and appropriate modifier use; collaborate with leadership and the coding team on resolution.
• Analyze and investigate complex insurance denials, identify or track payer-related trends, and inform leads and management of issues affecting reimbursement.
• Submit written and online correspondence and appeals to payers to obtain appropriate payment.
• Review claims and recommend adjustments to management; apply account adjustments when appropriate.
• Use payer websites to verify patient insurance information and claim status, payments, and denials, and to submit online appeals as needed.
• Maintain a thorough understanding of accounts receivable functions and department policies and procedures, and meet productivity and quality standards set by management.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED