High Impact Claims Specialist

Title: High Impact Claims Specialist

Location: Rockford, Illinois, 61107, United States

Work Type: Remote, Full Time

Job ID: HIGHI010983

Department: Clerical

Job Description:

At Rosecrance, we’ve been leading the way in behavioral health services for over a century. Our team empowers individuals and families to overcome substance use and mental health challenges through compassionate care and evidence-based therapies. If you’re ready to make a meaningful impact, we’re ready to welcome you! We are looking for dedicated individuals to join our team and help deliver on our mission of hope and recovery.

Position Purpose: The High Impact Claims Specialist will serve as a primary resource to identify high dollar collection issues with our commercial payors, increase revenue and track and trend payor collection issues.  This role will work closely with management to support the A/R team’s collection efforts. Qualifications/Basic Job Requirements:

Qualifications/Basic Job Requirements:

• High School diploma or GED

• Minimum of ten years’ experience in researching and solving high dollar complex insurance claims and denials. 

• Computer proficiency in a Windows environment, knowledge of Microsoft Office products with an emphasis in Excel.

• Adequate written skills to accurately complete required documentation within the time frames prescribed 

• Excellent organizational and customer service skills

• Must be emotionally and medically able to perform essential job responsibilities

• Must be free from active or infectious diseases

Essential Responsibilities:

1. Review and process all BC/BS and Commercial high dollar claims (over $10,000) for denials, payor issues and payment trends. 

2. Submit, process and track all appeals for BC/BS and commercial payors.  Maintain knowledge of ERISA laws governing employee benefit plans and manage the appeal process for these claims.

3. Assist A/R staff with complex claim issues they are unable to resolve in a timely manner.

4. Track and trend all Single Case Agreements. Work closely with Contracting on any SCA payment issues / concerns.

5. Review payments for BC/BS and commercial payors for rate validation according to our contracts.

6. Track all denial outcomes for payment, write-offs and transfers to client liability. Identify the root cause for the adjustments to client accounts. Work with management to review adjustment trends and identify potential solutions.

7. Help maintain integrity of accounts receivable ledger, including aged receivable monitoring on an ongoing basis. 

8. Responsible for maintaining current knowledge of revenue components including benefit plans, contract terms and rates and billing forms and codes.

9. Check status of claims through use of telephone, websites and/or other means available.

10. Document adjustments needed to patient accounts.

11. As needed, participate in phone conference calls with payors.

12. Pursue collection activities and follow up for balances outside of established norms.

13. Coordinate collection activities with outside agencies, including court appearances, as needed.

14. Provide feedback & education management with regards to issues that impact revenue flow.

15. Provide appropriate documentation and reports designed to assist in fiscal management of the agency.

16. Serve as a member of the SWAT Team and participate in team meetings.

17. Serve as a member of the Revenue Cycle Team and participate in all team meetings and activities.

18. Understand and comply with all of the principles established by the Rosecrance Corporate Compliance Program and Code of Ethics.

19. Perform all responsibilities in compliance with the mission, vision, values and expectations of Rosecrance.

20. Deliver exceptional customer service consistently to every customer.

21. Serve as a role model for other staff, clients and customers and demonstrate positive guest relations in representing Rosecrance.

22. Assume other related responsibilities as assigned by management.

Physical Requirements/Percentage of Work Time:

1. Vision:  Must be able to read printed and/or handwritten materials from a variety of sources  75-100%

2. Hearing:  Must be able to hear well enough to communicate with coworkers 50-79%; answer incoming phone calls  25-49%; interact with the public  25-49%

3. Standing/Walking/Mobility:  Must have mobility between departments within the facility 25-49%

4. Climbing/Stooping/Kneeling:  0-24%

5. Lifting/Pulling/Pushing:  Must exert up to 20 pounds of force occasionally and/or up to 5 pounds of force frequently to lift or move objects  25-49%

6. Fingering/Grasping/Feeling:  Must be able to finger keyboard for computer work and phone equipment for placing/receiving calls  50-74%

7. Sitting:  must be able to sit for prolonged periods of time when using the computer  25-49%

Environment:

Exposure to bloodborne pathogens requiring the use of universal precautions and/or personal protective equipment.

Exposure to computers.

Schedule: `8-hour shifts  

• Friday-Monday 830a-5p

Compensation & Rewards Based on education, experience, and credentials

• Starting pay - $22.47/hr

Work Location: Remote-Rockford, IL

Our Benefits

Rosecrance values its employees and offers a comprehensive benefits package for you and your family:

• Medical, dental, and vision insurance (multiple plan options to meet your needs)
• 401(k) with employer match & discretionary contribution
• Group Life Insurance, LTD and AD&D
• Tuition assistance & licensure/certification reimbursement
• Paid Time Off, sick time, bereavement leave
• Referral program earning up to $1,000 per hire!
• Wellness program, including an on-site gym at select facilities
• Discounts at participating retailers
• Daily pay available through UKG Wallet for financial flexibility

Who We Are

Rosecrance has been at the forefront of providing behavioral health services for over a century. Our mission is to empower individuals and families to overcome substance abuse and mental health challenges through evidence-based therapies and compassionate care. Join us in our mission to foster lasting recovery and transform lives.

We are committed to providing careers that make a difference in the lives of the people we serve and the people we employ. We do this through the work we do, our core mission and values, our employee resources, and especially through our purpose-driven community of opportunity and hope.