The Claims Specialist is responsible for following up directly with commercial and governmental payers to resolve billing issues and secure appropriate reimbursement in a timely manner. This individual identifies and analyzes denials and payment variances and enacts corrective measures as needed to effectively communicate and resolve payer errors.
Job Duties & Responsibilities
- Review denied and underpaid claims, identify discrepancies, and follow up with payers to ensure timely reimbursement.
- Analyze trends in denials and payment variances, working with management to address root causes and improve accounts receivable (A/R) performance.
- Maintain knowledge of federal/state regulations and payer requirements to ensure billing compliance.
- Handle communications with payers and internal departments professionally and efficiently.
- Participate in continuous quality improvement, setting and tracking performance goals.
- Identify and report trends, making recommendations to management for process improvements.
- Ensure HIPAA compliance when handling patient information.
- Support a team-oriented work environment with open communication and active listening.
- Promote department goals and hospital mission, maintaining compliance with external agency requirements (e.g., Joint Commission, State of Wisconsin).
- Assist with training and onboarding of new staff and student interns.
- Participate in committees, performance improvement initiatives, and team projects.
- Demonstrate professionalism, organization, and problem-solving skills while fostering a positive and solution-focused work culture.
- Provide technical guidance and influence cross-departmental processes.
Additional Job Description:
Education/Training Requirements:
- High school diploma or equivalent required
- Minimum of one year of relevant experience in mental health or medical insurance billing and/or collections required
- Demonstrated knowledge of and experience with third-party payer guidelines, reimbursement, follow-up, and collections
- Demonstrated knowledge of claims review and analysis; ICD-10, CPT, and HCPCS coding; and medical terminology
- Effective communication, leadership, organizational, and problem-solving skills
- Ability to manage multiple tasks and projects simultaneously
- Ability to analyze data, identify improvement, and implement change
- Strong interpersonal and customer service skills
- Proficiency with Microsoft Word, Excel, Outlook, Teams, OneNote and Oracle Health Patient Accounting systems.
- Ability to work quickly and effectively in a fast-paced detail-oriented environment while adhering to deadlines.
With a career at Rogers, you can look forward to a Total Rewards package of benefits, including:
- Health, dental, and vision insurance coverage for you and your family
- 401(k) retirement plan
- Employee share program
- Life/disability insurance
- Flex spending accounts
- Tuition reimbursement
- Health and wellness program
- Employee assistance program (EAP)
Through UnitedHealthcare, UMR and HealthSCOPE Benefits creates and publishes the Machine-Readable Files on behalf of Rogers Behavioral Health. To link to the Machine-Readable Files, please visit Transparency in Coverage (uhc.com)
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Rogers Behavioral Health
medical insurance, vision insurance, tuition reimbursement, 401(k), retirement plan
Feb 18, 2025