Billing Insurance Follow-up

Source Point Staffing (Old); Milwaukee (WI); On-site; USD 35,000 - 55,000; Full time

Job summary

An established industry player is seeking a detail-oriented Billing Specialist to manage and follow up on insurance claims. This role involves utilizing revenue cycle knowledge to ensure timely reimbursement and effective communication with both internal teams and external payors. The ideal candidate will have a strong understanding of medical terminology and billing practices, along with proficiency in relevant software systems. Join a dynamic team dedicated to excellence in healthcare billing, where your contributions will directly impact patient care and organizational success. If you are ready to make a difference in the healthcare industry, this opportunity is for you.

Qualifications

• 1 year of experience in a medical/billing reimbursement environment preferred.
• Ability to communicate effectively and understand medical documents.

Responsibilities

• Manage billing and follow-up on open insurance claims with attention to detail.
• Compile and maintain accurate online documentation of billing activities.

Skills

Revenue Cycle Knowledge

Communication Skills

Medical Terminology

Problem-Solving

Basic Keyboarding Proficiency

Education

High School Diploma or GED

Tools

EPIC

Patient Accounting System

Job description

Job Responsibilities

1. Prebilling/billing and follow-up activity on open insurance claims 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 act 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 claim to assure 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.

Minimum Requirements

1. High School Diploma or General Education Degree (GED)
2. Typically requires 1 year of related experience in a medical/billing reimbursement environment or an 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).

No Phone Calls Please. Qualified applicants may apply online, send a resume to Karyn Dowling, Talent Acquisition Specialist, Sixteenth Street Community Health Centers, 1337 S Cesar E Chavez Dr., Milwaukee, WI 53204, or fax to 414-672-0413. Sixteenth Street Community Health Centers is an equal employment opportunity employer.