Account Resolution Rep Sr

Sr. Account Resolution Representative

At Children's Wisconsin, we believe kids deserve the best. Children's Wisconsin is a nationally recognized health system dedicated solely to the health and well-being of children. We provide primary care, specialty care, urgent care, emergency care, community health services, foster and adoption services, child and family counseling, child advocacy services and family resource centers. Our reputation draws patients and families from around the country. We offer a wide variety of rewarding career opportunities and are seeking individuals dedicated to helping us achieve our vision of the healthiest kids in the country. If you want to work for an organization that makes a difference for children and families, and encourages you to be at your best every day, please apply today.

Job Summary : Responsible for the review, follow-up and collection of Government, HMO, and Commercial insurance accounts receivable. This role performs comprehensive follow-up activities that facilitates cash collections and ensures that claims are paid according to contract or at the accepted reimbursement dollar amount. The Sr. Account Resolution Rep is generally responsible for inpatient, surgical, and oncology accounts but may be called on to assist with other patient claims.

Essential Functions :

• Utilizes hospital computer billing system(s) to follow-up on unpaid, underpaid, and credit balance accounts.
• Performs various collection actions including contacting patients / parents, insurance companies, correcting and resubmitting claims and filing appeals in order to achieve claim resolution
• Investigates credit balances to include research of EOB's and verification of accurate contractual discounts. Review written requests for refunds from insurance companies and other payers to protect CHW's financial interests and completes appropriate paperwork for management authorization.
• Maintains current knowledge of managed care payer contracts and third party payer billing / reimbursement policies for all lines of business (Government, HMO and Commercial)
• Utilizes payer websites and electronic eligibility clearinghouses to verify the accuracy of patient insurance information and check claims payment status.
• Files online and / or paper appeals as necessary to obtain proper payment on claims.
• Analyzes payer errors and / or denials to identify trends. Keeps Lead and Management informed of issues that impact cash flow.
• Prepares month-end contractual reports for the Finance Department and other statistical reports as needed.
• Handles outside audits and edits of charges.
• Reviews and recommends write off of claims to management as appropriate.

Legacy Essential Functions :

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Required for All Jobs :

Fully Remote Work Opportunity! 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.