Medical Billing Resolution Specialist II

cwi; West Allis (WI); Sur place; USD 52 000 - 67 000; Plein temps

Résumé du poste

Children's Wisconsin is seeking a dedicated Professional Billing Specialist to resolve complex service insurance denials and maximize reimbursement from third-party payers. You will follow up on claims, review payer guidelines, and collaborate with the billing and coding teams to ensure accurate payments.

A minimum of 3 years in healthcare revenue cycle, knowledge of CPT/ICD-10, and strong communication are required.

Qualifications

• High School diploma or GED required; hospital revenue cycle experience preferred.
• 3 years of claims follow-up and reimbursement experience in healthcare.
• Strong knowledge of CPT-4/ICD-10 and payer guidelines.

Responsabilités

• Resolves complex service insurance denials and seeks maximum reimbursement.
• Performs follow-up with guarantors and insurance companies and resubmits claims.
• Reviews payer guidelines and applies modifiers for accurate payments.
• Identifies coding issues and collaborates with leadership and coding teams.
• Analyzes denials, tracks trends, and communicates findings to management.
• Submits appeals and maintains documentation for payer follow-up.
• Maintains understanding of A/R, policies, and productivity standards.
• Utilizes payer websites to verify eligibility and claim status.

Connaissances

Medical terminology

ICD-10/CPT knowledge

Analytical skills

Communication skills

Teamwork

Microsoft Office

Formation

High School diploma or GED

Outils

Epic Resolute

MS Office

Description du poste

Children's Wisconsin is seeking a dedicated Professional Billing Specialist to resolve complex service insurance denials and maximize reimbursement from third-party payers. You will follow up on claims, review payer guidelines, and collaborate with the billing and coding teams to ensure accurate payments.

A minimum of 3 years in healthcare revenue cycle, knowledge of CPT/ICD-10, and strong communication are required.