Claims Denials & Reimbursement Specialist

Rogers Memorial Hospital; Town of Oconomowoc (WI); Sur place; USD 42 000 - 54 000; Plein temps

Résumé du poste

Rogers Memorial Hospital is seeking a Claims Specialist to follow up with commercial and governmental payers, resolve billing issues, and ensure timely reimbursement. You will analyze denials, report payer discrepancies, and support department goals through effective communication and process improvement.

The role requires understanding of payer guidelines, HIPAA compliance, and the ability to handle multiple tasks in a fast-paced environment.

Qualifications

• High school diploma or equivalent required.
• Minimum of one year of relevant experience in medical billing and/or collections.
• Demonstrated knowledge of third-party payer guidelines, reimbursement, follow-up, and collections.
• Demonstrated knowledge of claims review and analysis including ICD-10, CPT, and HCPCS, 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.

Responsabilités

• 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 payers' requirements and explanations of benefits.
• Handles communications from payers and departments with the business office.
• Participates in continuous quality improvement efforts, tracking progress with supervisors.
• Promotes HIPAA compliance when handling patient information.
• Performs other duties as assigned.

Connaissances

Communication

Leadership

Organizational skills

Problem solving

Formation

High school diploma or equivalent

Outils

Microsoft Word

Excel

Outlook

Teams

OneNote

Description du poste

Rogers Memorial Hospital is seeking a Claims Specialist to follow up with commercial and governmental payers, resolve billing issues, and ensure timely reimbursement. You will analyze denials, report payer discrepancies, and support department goals through effective communication and process improvement.

The role requires understanding of payer guidelines, HIPAA compliance, and the ability to handle multiple tasks in a fast-paced environment.