Claims Resolution Specialist

Come work where passion, quality, vision, professionalism, and synergy are valued! BayCare Clinic's mission is to provide measurably superior specialty medical services to our patient

BayCare Clinic Corporate Headquarters is looking for a Claims Resolution Specialist in Green Bay, WI. We’re looking for a detail oriented, thoughtful candidate who wants to contribute to a positive experience for all our patients. This role is full time, with flexibility between our core hours of 7:00 a.m. - 5:00 p.m., Monday-Friday. No Holidays! No Weekends!

The Clinic

BayCare Clinic is a successful, dynamic group comprised of 19 specialties. We are a physician-owned entity with joint ownership in Aurora BayCare Medical Center, a 167-bed hospital located in Green Bay, WI, offering us a built-in referral base. Each of our specialty practices have clinical autonomy and are financially sound.

BayCare Clinic offers part-time and full-time employees a comprehensive benefits package including health, dental, disability and life insurance, as well as flexible spending options. We also offer a 401k retirement plan with a company match, generous PTO, and paid holidays.

The Team

The unique skills and talents of each member of our team contributes to our synergy and our overall goal of providing our patients with excellent care. We believe in the power of a positive, collaborative culture, and we strive to provide a supportive and energizing work environment.

Every member of our team has a voice and is trusted to have ownership over their work. To encourage this, we provide regular opportunities for professional development, we seek out feedback and ideas, and we invite participation on a variety of projects.

The Job

• Researches and processes denials from all payers in a timely manner, with an awareness of payer-specific policies, to obtain payment or propose financial adjustments/write-offs.
• Demonstrates effective decision making skills in dealing with the payers to resolve the claim to include: making appropriate inquiries of the payers, editing and re-filing of claims, assuring follow-up activities and managing correspondence.
• Identifies problems with accounts and follows through to resolution, notifying supervisor or appropriate personnel of trends/problems involving claims and/or payers.
• Demonstrates BayCare Health Systems operational knowledge and system competency to effectively resolve inquiries and issues.
• Complies and adheres to pertinent policies and procedures.
• Maintains high quality and productivity levels.
• Respects and maintains confidentiality.
• Works in a safe, compliant, and ethical manner at all times.
  
  

The Requirements

• A minimum of three years experience in a patient accounts setting with knowledge of the patient account continuum, claims processing and insurance benefits, medical terminology, CPT, ICD-9, HCPCS, RVU, coding, state and federal regulatory compliance laws, customer service, is strongly preferred.
• Knowledge of insurance principles and insurance contracts.
• Proficient with Microsoft Word, Excel, and internet.
• Strong writing and verbal skills with ability to communicate complex concepts.
• Problem solving skills, ability to systematically analyze problems, draw relevant conclusions, and devise appropriate courses of action.
• Self-starter with the ability to work independently.
• Excellent interpersonal, communication and organizational skills