Medical Claims Specialist

Dunn County•Dunn County Government Center, WI

10d

About The Position

Join our team as a Medical Claims Specialist, where you’ll provide vital fiscal support to the Department of Human Services. In this role, you’ll manage detailed billing functions—from charge entry and insurance claims to accounts receivable and revenue reconciliation—ensuring accuracy and compliance every step of the way. You’ll also collaborate closely with internal partners, maintain up-to-date knowledge of billing guidelines, and help streamline processes that keep our operations running smoothly. If you’re detail-oriented, proactive, and ready to make an impact in a mission-driven environment, we’d love to meet you.

Requirements

Associate’s Degree in Accounting, Finance, or other related field.
Minimum of two (2) years previous medical billing or finance experience.
Valid driver’s license or the ability to travel between work locations.
Prior to hire, a background check including criminal record history will be conducted.
Knowledge of general office procedures and practices.
Experience with general office productivity software (i.e. Microsoft Office Suite, Google Suite, relational database programs, etc.), general office equipment and computers.
Knowledge of billing, collection, reimbursement and reconciling practices, requirements and rules.
Skill in implementing, monitoring and maintaining accounting records, accounts payable, accounts receivables and general ledgers.
Ability to apply department and/or county specific procedures, policies, and operational routines pertaining to assigned areas of responsibility.
Ability to implement billing procedures and processes of the department.
Ability to assist managers in compiling and preparing budget information and assisting in tracking and monitoring approved budgets.
Ability to prepare required agency financial reports and documents required by state, federal or local funding agencies and sources.
Ability to establish and maintain effective and professional working relationships.
Ability to manage time effectively, manage multiple projects, and complete work within established deadlines.
Ability to work the allocated hours of the position.
Ability to communicate effectively with other members of the staff, supervisor, and customers.
Ability to communicate clearly and concisely in both written and verbal form.
English skills (oral, written and comprehension) sufficient to effectively communicate with all internal and external customers.
Ability to understand and effectively carry out verbal and written instructions.
Must have ability to work accurately with attention to detail.
Ability to prepare and maintain accurate and concise records and reports.
Adheres to HIPAA privacy regulations.
Ability to make arithmetic computations using whole numbers, fractions and decimals.
Ability to compute rates, ratios and percentages.
Ability to understand and apply governmental accounting practices in maintenance of financial records.

Responsibilities

Performs specialized accounting and bookkeeping support activities for the department.
Manages the assignment of Accounts Receivable by recording payments, maintaining receipt spreadsheets, and downloading remits for deposits.
Responds professionally to customer billing inquiries and ability to pay issues.
Performs charge entry, creates invoices and statements.
Bills insurance companies using UB-04 and 1500 forms.
Mails statements to consumers/ residents.
Analyzes consolidated billing invoices for payment and charge entry.
Verifies and reprices invoices per department procedures and CMS guidelines.
Codes deposits for general ledger posting, enters invoices for payment for general ledger posting.
Remains aware of current billing/coding guidelines and informed of changes to current rules; Makes recommendations for process change and creates training documents for reference.
Creates resident/consumer accounts with correct payers; verifies correct census and insurance coverage, monitors for discrepancies and fixes errors if found.
Manages prior authorization process.
Manages subsidiary ledgers in program-based software.
Manages changes to the charge master.
Acts as Super User, trouble shoots, recommends updates to financial modules.
Works with Manager to ensure electronic transactions are accurately posted.
Requests write-offs and initiates payment plans for residents /consumers.
Reconciles month-end revenues; creates journal entries that are needed to balance cash receipts; uploads journal entries created by Accounting Manager, Provides Accounting Managers with revenue reports.
Responds to customer payment and billing inquiries.
Communicates by writing and telephone with appropriate parties (i.e. Power of Attorney, Guardian) and ensures proper release of information is documented.
Reviews all providers contact notes completed by professional staff before submission to payer sources for all Behavioral Health and Birth to Three Program providers to ensure correct coding and documentation appear in the note as required by State and/or Federal billing and documentation guidelines for the service provided.
Initiates and assists with revenue contract development.
Completes group, facility and individual provider credentialing with all payers.
Coordinates with Medical Biller position to ensure tasks are completed timely.
Performs all related duties as assigned.