Pediatric Billing Resolution Specialist

cwi; West Allis (WI); Vor Ort; USD 48.000 - 72.000; Vollzeit

Zusammenfassung

Children's Wisconsin is seeking a Professional Billing Specialist to research and resolve overpaid and underpaid balances, and review insurance underpayments to maximize third-party reimbursements.

The role includes following up on inquiries related to billing discrepancies, collaborating with the Payer Contracting team, and ensuring accurate coding with CPT-4 and ICD-10 modifiers. Equal opportunity employer.

Qualifikationen

• 2+ years of experience in professional billing and follow up.
• Pediatric billing experience preferred.
• Experience in a large health system with professional billing claims is preferred.
• Medical billing experience preferred.

Aufgaben

• Investigates credit balances and reviews EOBs and contractual discounts.
• Maintains knowledge of billing guidelines for Professional Billing.
• Collaborates with Payer Contracting to understand payer policies across lines of business.
• Identifies CPT-4/ICD-10 coding issues and appropriate modifiers.
• Uses payer websites to verify insurance, claim status, payments, denials, and appeals.
• Analyzes improper insurance credits and tracks payer-related trends.
• Works with Lead and Manager to resolve claim/credit issues.
• Submits appeals to payers to maximize reimbursement.
• Maintains productivity and quality standards as required.

Kenntnisse

Communication skills

Independence

Interpersonal skills

Multi-tasking

Ausbildung

High School diploma or GED

Tools

Epic Resolute

Microsoft Office

Jobbeschreibung

Children's Wisconsin is seeking a Professional Billing Specialist to research and resolve overpaid and underpaid balances, and review insurance underpayments to maximize third-party reimbursements.

The role includes following up on inquiries related to billing discrepancies, collaborating with the Payer Contracting team, and ensuring accurate coding with CPT-4 and ICD-10 modifiers. Equal opportunity employer.