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
This position will be responsible for coordinating the prior-authorization, billing, and collection activities for all transplant patients. This position will also be responsible for coordinating the pre-authorization, billing, and collection activities for out of service area patients who at the time of scheduling do not have an adequate payment source, or who are self pay and in need of financial arrangements. This position will also be responsible for coordinating the pre-authorization, billing, and collection activities for payers requiring special handling and/or contract arrangements.

Essential Functions:

• Coordinates the revenue cycle process for transplant accounts. Responsible for obtaining payer prior authorization of transplant accounts. Determines CHW’s network status with payer to ensure satisfactory financial outcomes for CHW/MCW and the patient family.

• Prepares cost estimates and obtains Administrative approval as needed. Oversees the billing of transplant accounts to ensure that claims are submitted within the proper date parameters, sent to the proper addresses, and contractual discounts are applied according to the applicable contracts. Works with the transplant coordinators to ensure that donor charges are correctly identified, entered, and billed for.

• Maintains payer website(s) to ensure accurate claims processing by transplant network(s).

• Assists staff with follow-up when necessary to ensure prompt payment of transplant claims. Processes bundled package claims that include professional charges according to transplant contract guidelines. Reconciles bundled billed accounts to ensure proper payment for hospital and professional claims. Prepares check requests as needed.

• Meets with prospective transplant families to assess insurance coverage and keep the family informed of coverage issues and potential out of pocket costs. Reviews primary insurance coverage, secondary insurance coverage, out of pocket costs to include co-pay’s, deductibles, co-insurance, max benefit levels, and non-covered services. Reviews prior authorization requirements and keeps family informed of the status of prior authorization requests. Also reviews with the family eligibility requirements for government programs including, Medicare, Medicaid (SSI and State), and any other funding sources that may be available. Serves as the primary liaison between the insurance company(s) and the clinical team. Serves as the primary contact point for transplant patient families regarding insurance and payment questions

• Assists Access Center Team to coordinate the revenue cycle process for out of service area (including international) patients. Prepares cost estimates and obtains Administrative approval as needed. Oversees the billing of out of service area accounts to ensure that claims are submitted within the proper date parameters, sent to the proper addresses, and contractual discounts are applied according to the applicable contracts. Collects pre-payments as needed. Serves as primary contact for patients, providers, and payers for out of service area accounts. Reconciles hospital and professional charges against payments received as necessary. Prepares check requests as needed.

• Assists Access Team to coordinate the revenue cycle process for international patients seen through the Embassy payment program. Prepares bundled billing packages for submission to Embassy payers. Documents billed amounts for all providers on a spreadsheet. Performs payment follow up activities as needed with Embassy contacts. Applies contractual adjustments to CHW accounts according to Embassy contract terms. Reconciles Embassy payments to coordinate and dispurse funds received to the various providers.

• Coordinates the revenue cycle process for patients in the “Heal the Children” charity care program.

• Serves as a resource for Patient Accounts staff to assist in resolving problem and/or high dollar accounts. Contacts parents and payers as needed to resolve payment issues.

Education:

• Bachelor's Degree preferred

• or relevant experience

Experience:

• 2+ years experience in complex patient accounting/billing required

Knowledge, Skills and Abilities:

• Experience in managed care, Medicare, Medicaid or other health insurance environment is preferred.

• Requires the ability to analyze problems relating to the efficiency of the billing and collection functions.

• Requires excellent written and verbal communication skills in order to effectively interact with payers, physicians, and employees from other hospital departments in the resolution of problems.

• Microsoft Office skills to include Word and Excel.

• Strong organizational and time management skills

• Ability to prioritize tasks to ensure efficient workflow and excellence in work standards

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.

Fully Remote Work Opportunity!

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: