What are the responsibilities and job description for the Claims Specialist position at Rogers Behavioral Health?
The Claims Specialist is responsible for following up directly with commercial and governmental payers to resolve billing issues and secure appropriate reimbursement in a timely manner. This individual identifies and analyzes denials and payment variances and enacts corrective measures as needed to effectively communicate and resolve payer errors.
Job Duties & Responsibilities
- Review denied and underpaid claims, identify discrepancies, and follow up with payers to ensure timely reimbursement.
- Analyze trends in denials and payment variances, working with management to address root causes and improve accounts receivable (A / R) performance.
- Maintain knowledge of federal / state regulations and payer requirements to ensure billing compliance.
- Handle communications with payers and internal departments professionally and efficiently.
- Participate in continuous quality improvement, setting and tracking performance goals.
- Identify and report trends, making recommendations to management for process improvements.
- Ensure HIPAA compliance when handling patient information.
- Support a team-oriented work environment with open communication and active listening.
- Promote department goals and hospital mission, maintaining compliance with external agency requirements (e.g., Joint Commission, State of Wisconsin).
- Assist with training and onboarding of new staff and student interns.
- Participate in committees, performance improvement initiatives, and team projects.
- Demonstrate professionalism, organization, and problem-solving skills while fostering a positive and solution-focused work culture.
- Provide technical guidance and influence cross-departmental processes.
Additional Job Description :
Education / Training Requirements :
With a career at Rogers, you can look forward to a Total Rewards package of benefits, including :
Through UnitedHealthcare, UMR and HealthSCOPE Benefits creates and publishes the Machine-Readable Files on behalf of Rogers Behavioral Health. To link to the Machine-Readable Files, please visit Transparency in Coverage (uhc.com)
