Claims Submission Rep

Job Summary

Responsibility for the submission of all paper and electronic claims. This will include primary, secondary, and specialty claims. Will have assigned work-queues to correct billing, charging, and registration edits.

Essential Functions

• Facilitates the daily submission of electronic claims to the clearinghouse.
• Participates in the claims reconciliation process.
• Works assigned work-queues to correct billing, charging, and registration edits.
• Calculates and applies appropriate contractual discounts at the time of billing.
• Utilizes payer websites and electronic eligibility clearinghouses to verify the accuracy of patient insurance information.
• Utilizes payer websites for direct claim entry when necessary.
• SUBMIT SECONDARY CLAIMS TO PAYERS ACCORDING TO DEPARTMENT POLICY AND PROCEDURE AND PAYER GUIDELINES AND REQUIREMENTS.

Education

• High School graduate or Certificate of General Educational Development (GED) or High School Equivalency Diploma (HSED) required.

Experience

• 2+ years experience of billing and/or claims follow up, HCFAs and/or UB-04’s (preferably in a hospital setting) including insurance reimbursement procedures and comprehension of insurance EOB’s required.
• General pediatric and/or pediatric subspecialty experience preferred.
• Prior EPIC, QSI or IDX experience is strongly preferred.

Knowledge, Skills and Abilities

• Working knowledge of medical terminology, ICD-9, CPT and HCPCS level II codes.
• Excellent verbal and written communication skills.
• Bilingual skills a plus.
• Strong analytical skills and ability to perform non-complex arithmetic calculations when determining contractual allowances.
• Ability to work independently with minimal supervision.
• Proficient in Microsoft Office applications and technology skills required to perform duties.
• The ability to multi-task and function effectively in a team environment and maintain successful relationships with coworkers, patients, physicians, management, staff, and other customers.

Required for All Jobs

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that may be requested in the performance of this job. Employment is at-will. This document does not create an employment contract, implied or otherwise. Children's Wisconsin is an equal opportunity / affirmative action employer. We are committed to creating a diverse and inclusive environment for all employees. We treat everyone with dignity, respect, and fairness. We do not discriminate against any person on the basis of race, color, religion, sex, gender, gender identity and/or expression, sexual orientation, national origin, age, disability, veteran status, or any other status or condition protected by the law.

Certifications/Licenses

Certifications/licenses are not specified in the job posting.