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Rosecrance Behavioral Health · 2 months ago

High Impact Claims Specialist

Rockford, IL

Full-time

Onsite

Senior Level, Lead/Staff

$22.47/hr - $22.47/hr

10+ years exp

Rosecrance Behavioral Health has been a leader in behavioral health services for over a century, dedicated to empowering individuals and families. The High Impact Claims Specialist will be responsible for identifying high dollar collection issues, increasing revenue, and supporting the A/R team’s collection efforts.

Health Care

Responsibilities

Review and process all BC/BS and Commercial high dollar claims (over $10,000) for denials, payor issues and payment trends

Submit, process and track all appeals for BC/BS and commercial payors. Maintain knowledge of ERISA laws governing employee benefit plans and manage the appeal process for these claims

Assist A/R staff with complex claim issues they are unable to resolve in a timely manner

Track and trend all Single Case Agreements. Work closely with Contracting on any SCA payment issues / concerns

Review payments for BC/BS and commercial payors for rate validation according to our contracts

Track all denial outcomes for payment, write-offs and transfers to client liability. Identify the root cause for the adjustments to client accounts. Work with management to review adjustment trends and identify potential solutions

Help maintain integrity of accounts receivable ledger, including aged receivable monitoring on an ongoing basis

Responsible for maintaining current knowledge of revenue components including benefit plans, contract terms and rates and billing forms and codes

Check status of claims through use of telephone, websites and/or other means available

Document adjustments needed to patient accounts

As needed, participate in phone conference calls with payors

Pursue collection activities and follow up for balances outside of established norms

Coordinate collection activities with outside agencies, including court appearances, as needed

Provide feedback & education management with regards to issues that impact revenue flow

Provide appropriate documentation and reports designed to assist in fiscal management of the agency

Serve as a member of the SWAT Team and participate in team meetings

Serve as a member of the Revenue Cycle Team and participate in all team meetings and activities

Understand and comply with all of the principles established by the Rosecrance Corporate Compliance Program and Code of Ethics

Perform all responsibilities in compliance with the mission, vision, values and expectations of Rosecrance

Deliver exceptional customer service consistently to every customer

Serve as a role model for other staff, clients and customers and demonstrate positive guest relations in representing Rosecrance

Assume other related responsibilities as assigned by management

Qualification

Insurance claims expertiseMicrosoft Excel proficiencyCustomer service skillsOrganizational skillsWritten communication skills

Required

High School diploma or GED

Minimum of ten years' experience in researching and solving high dollar complex insurance claims and denials

Computer proficiency in a Windows environment, knowledge of Microsoft Office products with an emphasis in Excel

Adequate written skills to accurately complete required documentation within the time frames prescribed

Excellent organizational and customer service skills

Must be emotionally and medically able to perform essential job responsibilities

Must be free from active or infectious diseases

Benefits

Medical, dental, and vision insurance (multiple plan options to meet your needs)

401(k) with employer match & discretionary contribution

Group Life Insurance, LTD and AD&D

Tuition assistance & licensure/certification reimbursement

Paid Time Off, sick time, bereavement leave

Referral program earning up to $1,000 per hire!

Wellness program, including an on-site gym at select facilities

Discounts at participating retailers

Daily pay available through UKG Wallet for financial flexibility

Company

Rosecrance Behavioral Health

Glassdoor3.4

Rosecrance is a private not-for-profit organization offering behavioral health services for children, adolescents, adults and families throughout the country.

Founded in 1916

Rockford, Illinois, USA

1001-5000 employees