Job Purpose and Reporting Structure

The primary responsibility of this position is to work directly with insurance companies, healthcare providers, and patients to ensure claims are processed and paid. You will be required to review and appeal all unpaid and denied claims. This position demands an extraordinary level of attention to detail and the ability to multi-task in a high-volume, fast-paced, and exciting environment.

This position will report directly to the Revenue Cycle Supervisor.

Essential Duties and Responsibilities

• Ensure all claims are submitted with a goal of zero errors.
• Verify the completeness and accuracy of all claims prior to submission.
• Accurately post all insurance payments by line item.
• Follow up timely on insurance claim denials, exceptions, or exclusions.
• Meet deadlines.
• Read and interpret insurance explanation of benefits.
• Utilize monthly aging account receivable reports and/or work queues to follow up on unpaid claims aged over 30 days.
• Make necessary arrangements for medical records requests and completion of additional information requests from providers and/or insurance companies.
• Regularly meet with the Revenue Cycle Supervisor to discuss and resolve reimbursement issues or billing obstacles.
• Regularly attend monthly staff meetings and continuing educational sessions as required.
• Perform additional duties as assigned.
• Experience in filing claim appeals with insurance companies to ensure maximum entitled reimbursement.

Education and/or Experience:

• High school diploma with at least two years of experience in healthcare, billing, and alternate payor reimbursement claims processing.
• Previous experience with medical terminology and coding.
• Professional oral, written, and presentation communication skills.
• Experience with Medicare and Medicaid claims is helpful.
• Knowledge of insurance, managed care, PPO, FQHC billing, and Milwaukee County systems is preferred.
• Ability to work under pressure.
• Ability to establish and maintain effective working relationships with patients, medical staff, coworkers, and the public.
• Ability to read, write, and communicate effectively, both orally and in writing.

Considerations & Statement

Outreach Community Health Centers requires employees in certain departments to be fully vaccinated against MMR (Measles, Mumps, Rubella), Varicella (Chickenpox), and Influenza.

Outreach Community Health Centers Welcomes All

Outreach Community Health Centers, Inc. is an Affirmative Action/Equal Opportunity Employer. We consider qualified applicants for employment without regard to race, religion, color, national origin, ancestry, age, sex, gender, gender identity, gender expression, sexual orientation, genetic information, medical condition, disability, marital status, or protected veteran status.