Ministry Health Care Claims Resolution Representative - Revenue Cycle - Medicare HMO%27s - 32hr/wk in Appleton, Wisconsin

Title: Claims Resolution Representative - Revenue Cycle - Medicare HMO%27s - 32hr/wk Location: WI-Appleton-222 West College Avenue Job Number: R-1408683

The Claims Resolution Representative is responsible for all aspects of Facility and Provider Billing, research and patient account resolution on Insurance pending balances for all payers, including problems with carrier reimbursement and denials. This position is also the primary resource and contact for Insurance payer issues and is responsible for knowing current rules and regulations for each payer. • Reviews, edits, resubmits claims • Ensure compliance with payer rules and regulations • Performs routine follow-up on outstanding insurance balances • Responds to insurance correspondence • Review worklists/reports/systems to identify and work appropriate accounts to maximize AR reduction and minimize write-offs • Reviews payer denials and underpayments and researches and acts to reach account resolution • Develop competency with billing and health information systems • Resolve billing system claim edits • Master the requirements of the UB04/CMS 1500 claim forms to bill a clean and accurate claim to payers • Provide support to all Revenue Cycle and clinical departments in resolution of account inquiries or payer issues Qualifications: High school diploma or equivalent Entry-level position, previous healthcare revenue cycle experience preferred Skills Required: *High volume 10-key usage • Basic knowledge of Microsoft Office products (Excel, Word, Outlook) and web-based applications • Effective verbal and written communication and positive interpersonal skills • Excellent organizational skills with the ability to prioritize and handle multiple tasks • Critical thinking, problem solving, investigative, and decision-making skills • Ability to use tact and diplomacy with patients and internal customers in all situations • Attention to detail Job: Insurance/Billing