Located in Milwaukee, Wisconsin, Children's Wisconsin, formerly Children's Hospital of Wisconsin, is one of the country’s leading pediatric hospitals and the only independent hea
Claims Submission Representative - Remote
Location
United States
Posted
84 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Claims Submission Representative - Remote
Children's Wisconsin
At Children’s Wisconsin, we believe kids deserve the best. Children’s Wisconsin is a nationally recognized health system dedicated solely to the health and well-being of children. We provide primary care, specialty care, urgent care, emergency care, community health services, foster and adoption services, child and family counseling, child advocacy services and family resource centers. Our reputation draws patients and families from around the country. We offer a wide variety of rewarding career opportunities and are seeking individuals dedicated to helping us achieve our vision of the healthiest kids in the country. If you want to work for an organization that makes a difference for children and families, and encourages you to be at your best every day, please apply today. Please follow this link for a closer look at what it’s like to work at Children’s Wisconsin: https://www.instagram.com/lifeatcw/ Job Summary Responsibility for the submission of all paper and electronic claims. This will include primary, secondary, and specialty claims. Will have assigned work-queues to correct billing, charging, and registration edits. Essential Functions - Facilitates the daily submission of electronic claims to the clearinghouse. Along with the Lead, participates in the claims reconciliation process. - Works assigned work-queues to correct billing, charging, and registration edits. - Calculates and applies appropriate contractual discounts at the time of billing. - Utilizes payer websites and electronic eligibility clearinghouses to verify the accuracy of patient insurance information. - Utilizes payer websites for direct claim entry when necessary. - Submits secondary claims to payers according to department policy and procedure and payer guidelines and requirements. Education: - High School graduate or Certificate of General Educational Development (GED) or High School Equivalency Diploma (HSED) required Experience: - 2+ years experience of billing and/or claims follow up , HCFAs and/or UB-04’s (preferably in a hospital setting) including insurance reimbursement procedures and comprehension of insurance EOB’s required - General pediatric and/or pediatric subspecialty experience preferred - Prior EPIC, QSI or IDX experience is strongly preferred Knowledge, Skills and Abilities: - Working knowledge of medical terminology, ICD-9, CPT and HCPCS level II codes. - Excellent verbal and written communication skills. Bilingual skills a plus. - Strong analytical skills and ability to perform non‑complex arithmetic calculations when determining contractual allowances. - Ability to work independently with minimal supervision. - Proficient in Microsoft Office applications and technology skills required to perform duties. - The ability to multi-task and function effectively in a team environment and maintain successful relationships with coworkers, patients, physicians, management, staff, and other customers. Required for All Jobs: - This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that may be requested in the performance of this job. - Employment is at-will. This document does not create an employment contract, implied or otherwise. Children's Wisconsin is an equal opportunity / affirmative action employer. We are committed to creating a diverse and inclusive environment for all employees. We treat everyone with dignity, respect, and fairness. We do not discriminate against any person on the basis of race, color, religion, sex, gender, gender identity and/or expression, sexual orientation, national origin, age, disability, veteran status, or any other status or condition protected by the law. Certifications/Licenses:
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Claims Supervisor
GallagherInclusion and diversity (I&D) is a core part of our business, and it’s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work. Gallagher embraces our employees’ diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest. Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on protected characteristics by applicable federal, state, or local laws.
Introduction At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it’s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people’s lives. It takes empathy, precision, and a strong sense of partnership—and that’s exactly what you’ll find here. We’re a team of fast-paced fixers, empathetic experts, and outcomes drivers — people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you’ll play a vital role in helping businesses and individuals move forward with confidence. Here, you’ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you’re here, you’re part of something bigger. You’re part of a team that shows up, stands together, and leads with purpose. 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Revenue Cycle Coverage and Claims Associate I
Exact SciencesChanging the way we think about detecting and treating cancer.
Help us change lives At Exact Sciences, we’re helping change how the world prevents, detects and guides treatment for cancer. We give patients and clinicians the clarity needed to make confident decisions when they matter most. Join our team to find a purpose-driven career, an inclusive culture, and robust benefits to support your life while you’re working to help others. Position Overview The Revenue Cycle Coverage and Claims Associate I will be responsible for the accurate and timely work of filing insurance claims for Exact Sciences. This role will demonstrate medical insurance knowledge by determining initial and/or ongoing eligibility, coverage, and related insurance reimbursement order details, including commercial, government, and all various plan coverage. This role will identify order and reimbursement deficiencies, route orders for appropriate actioning, and document actions taken within the systems for claims lifecycle tracking. This role will also support the broader activities of ensuring appropriate coverage by utilizing Epic, external portals, and other software, and communicate insurance information to ancillary departments and other teams within the reimbursement operations departments. This position is remote. 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Exact Sciences will make a reasonable accommodation available, if necessary, to assist an employee with a disability to satisfy this requirement. Minimum Qualifications - High School Diploma or General Education Degree (GED). - 3+ months of experience in any healthcare field. - Strong knowledge of order management, insurance claims procedures, electronic health record (EHR) operating systems. - Basic knowledge of medical terminology and/or health insurance terms. - Demonstrated strong attention to detail and focus on quality output. - Proficient with electronic health records. - Proficient in Microsoft Office programs, such as Word and Outlook. - Demonstrated ability to perform the essential duties of the position with or without accommodation. - Authorization to work in the United States without sponsorship. Preferred Qualifications - Associates Degree in field as outlined in the essential duties. - 1+ years of experience in the medical or insurance billing field. - Experience in revenue cycle platform applications. - Medical billing certification. #LI-AT1 $35,000-$57,000 Salary Range: $35,000.00 - $57,000.00 The annual base salary shown is for this position located in US - WI - Madison on a full-time basis. In addition, this position is bonus eligible. Exact Sciences is proud to offer an employee experience that includes paid time off (including days for vacation, holidays, volunteering, and personal time), paid leave for parents and caregivers, a retirement savings plan, wellness support, and health benefits including medical, prescription drug, dental, and vision coverage. Learn more about our benefits. Our success relies on the experiences and perspectives of a diverse team, and Exact Sciences fosters a culture where all employees can develop personally and professionally with a sense of respect and belonging. If you require an accommodation, please contact us here. Not ready to apply? Join our Talent Community to stay updated on the latest news and opportunities at Exact Sciences. We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to disability, protected veteran status, and any other status protected by applicable local, state, or federal law. To view the Right to Work, E-Verify Employer, and Pay Transparency notices and Federal, Federal Contractor, and State employment law posters, visit our compliance hub. The documents summarize important details of the law and provide key points that you have a right to know.




