Children's Wisconsin · 7 hours ago
Payment Resolution Analyst-Remote
United States
Full-time
Remote
Entry, Mid Level
2+ years expChildren's Wisconsin is a nationally recognized health system dedicated solely to the health and well-being of children. The Payment Resolution Analyst is responsible for researching and resolving professional billing overpaid and underpaid balances, ensuring claims are paid at maximum reimbursement, and following up on customer inquiries related to these issues.
AssociationBiotechnologyEducationHealth CareMedical
Responsibilities
Investigates credit balances to include research of EOB’s and verification of accurate contractual discounts. Reviews written requests for refunds from insurance companies and other payers to protect CHW’s financial interests and completes appropriate paperwork for management authorization
Maintains knowledge of primary care and complex specialty billing guidelines pertaining to each provider group for Professional Billing
Collaborates with Payer Contracting team and maintains current knowledge of managed care payer contracts and third-party payer billing/reimbursement policies for Professional Billing along with all lines of business (Government, HMO and Commercial)
Identifies coding issues relating to CPT-4 and ICD-10 and use of appropriate modifiers that resulted in overpayments/underpayments balances. Collaborates with leadership and coding team on resolution
Utilizes payer websites to verify patient insurance information, claim status/payments/denials/appeals as necessary
Analyzes and investigates improper insurance credits, identify and/or track trends associated to payers. Keeping leads and management appraised of identified issues having an impact on reimbursement
Works with Lead and Manager to resolve claim/credit issues
Submits written and online correspondences and appeals to payers when disputing a refund/recoup request as needed to obtain maximum reimbursement
Maintains productivity and quality standards as set by management
Qualification
Required
High School graduate or Certificate of General Educational Development (GED) or High School Equivalency Diploma (HSED) or Certificate of General Educational Development (GED) required
2+ years of experience in professional billing and follow up required
Working knowledge of medical terminology, ICD-10 and CPT
Excellent verbal and written communication skills
Ability to work independently with minimal supervision
Interpersonal skills necessary to efficiently respond to questions from patients, parents, clinic staff and insurance companies to effectively resolve billing issues
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 effective relationships with coworkers, patients, physicians, management, staff and other customers
Preferred
Pediatric experience preferred
Prior experience in a large health system working with professional billing claims and functions preferred
Medical billing experience preferred
Prior credit resolution/payment posting experience preferred
Experience in Epic Resolute preferred
Company
Children's Wisconsin
The Childrens Hospital Research Institute is a research institute dedicated solely to the health and well-being of children.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Gil Peri
President and Chief Executive Officer
J
Jason Jarzembowski
Chief Executive Officer
Recent News
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2026-01-19
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