Billing Insurance Follow-up

Sixteenth Street Community Health Centers; Milwaukee (WI); On-site; USD 42,000 - 54,000; Full time

Job summary

Sixteenth Street Community Health Centers in Milwaukee seeks a Billing Specialist to manage prebilling, billing and follow-up on insurance claims, applying revenue cycle knowledge and medical terminology.

You will obtain documentation from various resources, communicate with payers and external customers, validate information, enter data into the patient accounting system, and support claims appeals to ensure contracted amounts are received.

Qualifications

• High School Diploma or GED required.
• Typically 1 year of related medical billing experience.
• Experience with EPIC is preferred.
• Ability to read and interpret EOBs and insurance documents.
• Strong communication and accuracy in data entry.

Responsibilities

• Prebilling, billing and follow-up on open claims with revenue cycle knowledge.
• Obtain necessary documentation and communicate with internal teams and payers.
• Identify patterns related to coding, denials, and contract requirements for delays.
• Stay updated on payer changes and enter data into billing systems.
• Appeal claims to secure contracted reimbursement and monitor KPI targets.
• Maintain clear online documentation of all billing activity per guidelines.
• Read and follow Sixteenth Street policies; obtain supervisor approval as needed.

Skills

Effective communication

Attention to detail

Independent worker

Education

High School Diploma or GED

Tools

EPIC

Patient accounting system

Billing software

Job description

JOB RESPONSIBILITIES

1. Prebilling/billing and follow-up activity on open insurance claim exercising revenue cycle knowledge (i.e., CPT, ICD-10 and HCPCS, NDC, revenue codes, and medical terminology).
2. Will obtain the necessary documentation from various resources.
   Ability to timely and accurately communicate with internal teams and external customers (i.e., third-party payors, auditors, and other entities) and acts as a liaison with external third-party representatives to validate and correct information.
   Comprehends incoming insurance correspondence and responds appropriately.
3. Identifies and brings patterns/trends to leadership's attention regarding coding and compliance, contracting, claim form edits/errors, and credentialing for any potential delay/denial of reimbursement.
4. Obtains and keeps abreast with insurance payer updates/changes, and single case agreements and assists management with recommendations for implementation of any edits/alerts.
   Accurately enters and/or updates patient/insurance information into the patient accounting system.
5. Appeals claims to ensure the contracted amount is received from third-party payors.
   Complies and maintains KPI (Key Performance Indicators) for assigned payers within standards established by department and insurance guidelines.
   Compile information for referral of accounts to internal/external partners as needed.
6. Compile and maintain clear, accurate, online documentation of all activity relating to billing and follow-up efforts for each account, utilizing established guidelines.
   Responsible to read and understand all Sixteenth Street Community Health Center policies and departmental collections policies and procedures.
7. Demonstrate proficiency in the proper use of the software systems employed by SSCHC.
   This position refers to the supervisor for approval or final disposition such as recommendations regarding the handling of observed unusual/unreasonable/inaccurate account information.
8. Approval is needed to write off balances according to corporate policy. Issues outside the normal scope of activity and responsibility.

QUALIFICATIONS

1. High School Diploma or General Education Degree (GED)
2. Typically requires 1 year of related experience in a medical/billing reimbursement environment or equivalent combination of education and experience.
3. Experience in EPIC preferred
4. Must perform within the scope of departmental guidelines for productivity and quality standards.
5. Works independently with limited supervision.
6. Accountable and evaluated to organization behaviors of excellence.
7. Basic keyboarding proficiency.
8. Must be able to operate computer and software systems in use at Sixteenth Street Community Health Center.
9. Able to operate a copy machine, facsimile machine, telephone/voicemail.
10. Ability to read, write, speak, and understand English proficiently.
11. Ability to read and interpret documents such as an explanation of benefits (EOB), operating instructions, and procedure manuals.
12. Preferred but not required knowledge of medical terminology, coding, terminology (CPT, ICD-10, HCPC), and insurance/reimbursement practices.
13. Ability to communicate well with people to obtain basic information (via telephone or in-person).