Billing Specialist

Milwaukee Health Services; Milwaukee (WI); On-site; USD 45,000 - 65,000; Full time

Job summary

Milwaukee Health Services is seeking a Billing Specialist to manage claims and payment submissions across multiple payer types. You will focus on timely submission, follow-up, and resolving denials to maximize revenue and cash flow.

Responsibilities include working in the Charge Review and Claim Edit queues, researching denials, ensuring HIPAA compliance, and maintaining accurate notes in the EHR. A minimum of 2 years in revenue cycle is required.

Qualifications

• 2+ years revenue cycle experience in a medical setting.
• Knowledge of ICD-10, CPT, and HCPCS codes.
• HIPAA and PHI compliance knowledge.
• Strong interpersonal and communication skills.
• High attention to detail and multitasking ability.

Responsibilities

• Resolve all charges in the Charge Review Work Queue daily.
• Resolve all assigned claims in Claim Edit Work Queue daily.
• Resolve all payor rejections in the Follow Up Work Queue within 10 working days.
• Research and rebill/resolve all claim denials within 60 days of denial.
• Research and rebill all claims with no response from the payer within 60 days of the date billed.
• Monitor AR days for assigned departments, keeping AR days ≤ 45.
• Independently work to resolve claim denials to obtain payment.
• Process appeals within payer contract timely filing requirements.
• Research credit balances to determine if a refund is required and submit refund requests.
• Document actions on accounts in the EHR with clear notes.
• Contribute to the Billing Department team with professionalism and ethics.
• Participate in educational activities and team meetings.
• Maintain confidentiality in line with HIPAA regulations.

Skills

Revenue cycle experience

Attention to detail

Teamwork / interpersonal skills

HIPAA/PHI compliance

Education

High School Diploma

Tools

EHR system

Job description

The Billing Specialist role requires critical thinking skills and attention to detail. This position is responsible for timely submission/follow-up on claims for all payer types and multiple specialties. The Billing Specialist's role focuses on maximizing revenue and cash flow by completing these tasks in a timely, efficient manner.

Position-Specific Competencies/Essential Functions/Duties & Responsibilities:

• Resolve all charges in the Charge Review Work Queue daily.
• Resolve all assigned claims in Claim Edit Work Queue daily.
• Resolve all payor rejections in the Follow Up Work Queue within 10 working days.
• Research and rebill/resolve all claim denials within 60 days of the date of the denial.
• Research and rebill all claims with no response from the payer within 60 days of the date billed.
• Monitor AR days for assigned departments, maintaining AR days no greater than 45 days.
• Independently work to resolve claim denials to obtain payment.
• Process appeals within the timely filing requirements of the payer contract.
• Research credit balances to determine if a refund is required. Submit refund requests as needed.
• Document all actions on accounts in the EHR with clear, complete, and accurate notes.
• Contribute to the Billing Department team through positive attitude, respectful interaction, innovative ideas, efficiency, and ethical behavior.
• Participate in educational activities and attend team meetings.
• Maintain strict confidentiality; adhere to all HIPAA and PHI guidelines/regulations.

Required Knowledge, Skills and Abilities:

• Must have 2+ years of revenue cycle experience working in a medical setting; knowledge of ICD-10, CPT codes, and HCPCS codes.
• Working knowledge of insurance payment regulations including various reimbursement, co-insurance, and deductibles, and contractual adjustments (Medicare, Medicaid, managed care, commercial insurance, workers' compensation, and sliding fee scale).
• Working knowledge of HIPAA and PHI regulations and compliance.
• Strong interpersonal and communication skills to be able to work successfully in a team-oriented environment.
• High attention to detail and the ability to multitask.

Qualifications:

• Minimum Education Level: High School Diploma
• Minimum 2 years of on-the-job training in a FQHC or clinic, physician's office, or hospital setting.
• Hours may vary based on organizational need
• Travel may vary based on organizational need

EEO/AA: Milwaukee Health Services provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran by applicable federal, state and local laws. Our hiring and promotion policies focus on selecting the most qualified and capable candidates. Milwaukee Health Services complies with applicable state and local laws governing nondiscrimination in employment in every location where the company has facilities. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.