Claims Specialist

Rogers Behavioral Health•Oconomowoc, WI

2d•Onsite

About The Position

The Claims Specialist is responsible for following up directly with commercial and governmental payers to resolve billing issues and secure appropriate reimbursement in a timely manner. This individual identifies and analyzes denials and payment variances and enacts corrective measures as needed to effectively communicate and resolve payer errors.

Requirements

High school diploma or equivalent required
Minimum of one year of relevant experience in mental health or medical insurance billing and/or collections required
Demonstrated knowledge of and experience with third-party payer guidelines, reimbursement, follow-up, and collections
Demonstrated knowledge of claims review and analysis; ICD-10, CPT, and HCPCS coding; and medical terminology
Effective communication, leadership, organizational, and problem-solving skills
Ability to manage multiple tasks and projects simultaneously
Ability to analyze data, identify improvement, and implement change
Strong interpersonal and customer service skills
Proficiency with Microsoft Word, Excel, Outlook, Teams, OneNote and Oracle Health Patient Accounting systems.
Ability to work quickly and effectively in a fast-paced detail-oriented environment while adhering to deadlines.

Responsibilities

Examines denied and underpaid claims to determine reasons for discrepancies
Communicates directly with payers to follow up on outstanding claims, resolve payment variances, and achieve timely reimbursement
Works with management to identify, trend, and address root causes of denials; helps pinpoint strategies for reducing A/R
Maintains a thorough understanding of federal and state regulations, as well as specific payer requirements and explanations of benefits, to identify and report billing compliance issues and payer discrepancies
Effectively handles all communications, including telephone and email, from payers and departments with the business office
Participates in continuous quality improvement efforts on an ongoing basis, establishing goals with supervisors and tracking progress
Demonstrates initiative and resourcefulness by making recommendations and communicating trends and issues to management
Understand and maintains compliance with HIPAA guidelines when handling patient information
Performs other duties as assigned
Promote a team atmosphere by treating individuals with respect and honesty and by using direct communication and active listening skills.
Be open to change and actively support change.
Be open to others’ ideas and points of view.
Evaluate employees objectively and provide employees with periodic feedback.
Promote department goals as well as the mission of the hospital.
Communicate goals to fellow staff members.
Maintain department policies and procedures.
Include requirements and guidelines from external agencies (i.e., Joint Commission, State of Wisconsin).
Maintain and/or communicate to appropriate party function backlog at a set time.
Educate new staff regarding regulations or requirements of those functions that relate to their areas or departments, as directed.
Demonstrate acceptance and training of student interns in the department, as directed.
Participate in hospital committees, performance improvement team meetings, and team projects, as directed.
Demonstrate punctuality and preparedness.
Demonstrate effective communication skills.
Demonstrate good organizational skills.
Contribute in a positive, solution-focused manner.
Conduct self in a professional manner.
Demonstrate organizational skills that promote timely response to all inquiries and to task completion.
Communicate with all individuals in a positive and professional manner.
Attempt to resolve individual issues with peers in a positive, calm manner, with a focus on solution.
Communicate concerns and provide solutions for same.
Project a professional image by wearing appropriate, professional attire.
Ability to influence departments within Rogers and provide technical guidance.