Rosecrance Behavioral Health

Senior Insurance Claims Specialist

Rosecrance Behavioral Health

full-time

Posted on:

Location Type: Remote

Location: Illinois • Iowa • United States

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Salary

💰 $22 per hour

Job Level

Senior

About the role

  • 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.

Requirements

  • 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
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
claims processingappeals managementdenial resolutionroot cause analysisaccounts receivable managementrevenue cycle managementbilling forms and codescontract rate validationSCA payment trackingERISA laws
Soft Skills
organizational skillscustomer servicecommunication skillsproblem-solvingteam collaborationfeedback provisioneducational skillsrole modelingemotional intelligencetime management
Certifications
High School diplomaGED