Claims Resolution Specialist

Our Patient Accounts department is seeking a self-motived and organized Claims Resolution Specialist to join their team! We are willing to train the right candidate for this role!

This is a full-time position that offers remote possibilities (once training is completed) but will require that the individual work in the office in downtown Green Bay at least once per week and have the ability to come on-site for monthly department meetings or as needed. The hours for this position are Monday - Friday, 8:30am - 5pm (40 hours per week) with no nights, holidays or weekends!

The Claims Resolution Specialist performs tasks required to minimize the aging and ensure timely resolution of all insurance balances for BayCare Clinic and its patients. This individual will work collaboratively with all departments across the organization, to include clinic practice sites.

Description of Duties: 

• Researches and processes denials from all payers in a timely manner, with an awareness of payer-specific policies, to obtain payment or propose financial adjustments/write-offs.
• Demonstrates effective decision making skills in dealing with the payers to resolve the claim to include: making appropriate inquiries of the payers, editing and re-filing of claims, assuring follow-up activities and managing correspondence.
• Identifies problems with accounts and follows through to resolution, notifying supervisor or appropriate personnel of trends/problems involving claims and/or payers.
• Demonstrates BayCare Health Systems operational knowledge and system competency to effectively resolve inquiries and issues.
• Complies and adheres to pertinent policies and procedures.
• Maintains high quality and productivity levels.
• Respects and maintains confidentiality.
• Works in a safe, compliant, and ethical manner at all times.

Secondary Functions:

• Supports the Customer Service and Collections phone hunts as needed.
• Works to build customer loyalty.
• Participates in various projects as assigned.

Qualifications/Certifications/Licensure Needed:

• A minimum of three years’ experience in a patient accounts setting with knowledge of the patient account continuum, claims processing and insurance benefits, medical terminology, CPT, ICD-9, HCPCS, RVU, coding, state and federal regulatory compliance laws, customer service, is strongly preferred.
• Knowledge of insurance principles and insurance contracts.
• Proficient with Microsoft Word, Excel, and internet.
• Strong writing and verbal skills with ability to communicate complex concepts.
• Problem solving skills, ability to systematically analyze problems, draw relevant conclusions, and devise appropriate courses of action.
• Self-starter with the ability to work independently.
• Excellent interpersonal, communication and organizational skills.