Ann & Robert H. Lurie Children’s Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology, research and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of excellence, kids and their families are at the center of all we do. Ann & Robert H. Lurie Children’s Hospital of Chicago is ranked in all 10 specialties by the U.S. News & World Report.

Location

Job Description

General Summary:

Serves as the lead in the overall analysis of denials related to insurance accounts receivables. Acts as the subject matter expert on payor policies as it relates to reimbursement. Performs root cause analysis of denial categories and implements workflows to mitigate denials. Responsible for the coordination and completion of level III appeals with payors. Collaborates with division leaders, payor relations representatives, managed care, and other ancillary departments to support continuous denial strategy process improvement. Leverages system automation and clearinghouse functionality for clear claim processing.  Provides support to Account Service Representatives (ASR) in daily denial resolution tasks.

Essential Job Functions:

Works collaboratively with payors, patients, internal contacts, and third party follow up vendors to identify and rectify denial issues resulting in timely reimbursement and final disposition of claims.

Verifies accuracy of payment for correct reimbursement and resolves issues related to over/underpayments. Performs necessary error corrections and/or initiates a refund request to rectify the account overpayment. Documents all activities/actions taken on an individual patient account within the billing system.

Maintains knowledge of all regulations by continually enhancing education specific to federal regulations, payor communications, federal registrars and contractual guidelines to ensure compliance. Maintains familiarity with government and commercial payor policies via web sites and portals and can research and interpret them effectively.

Participates in scheduled payor meetings by preparing and documenting open issues log (update balances, open A/R, discussion notes) and dispute spreadsheets

Prepare, submit, track, and maintain resolution of level II and III appeals

Works with our internal and external customers to maintain data integrity within patient accounting systems.

Works closely with Customer Service, Patient Relations, Risk Management, and Compliance to provide follow up and direction with complicated account inquiries.

Performs complex guarantor account reviews on all financial classes related to outstanding insurance claim balance.

Actively participates in analysis of work processes; documents and provides feedback to assist in enhancing overall patient satisfaction and work process improvements.

Participates actively in department meetings, providing updates to AR Teams and leadership. Assumes additional responsibilities and special projects as assigned.

Collaborate with other departments to ensure smooth work processes (Consolidated Services, Accounts Payable, Finance, etc.).

Act as an Epic Super User and Application/Task Tester for Physician Billing projects

 Performs job functions adhering to service principles with customer service focus of innovation, service excellence and teamwork to provide the highest quality care and service to our patients, families, co-workers, and others.

Performs other job-related tasks as assigned.

Education and Experience:

High school graduate required. Associates, BS or BA degree preferred.

Five to seven years of physician billing experience and/or training. Minimum of three years of business office experience in physician office setting.

CPC certification highly preferred. Extensive knowledge of ICD-10, CPT coding, medical terminology, third party billing and collections, required.

Ability to perform financial analysis and create reports using Microsoft Office products.

Strong leadership, planning, and organizational skills with strong analytical ability.

Strong project management skills with keen attention to details.

Previous Epic experience desired.

Excellent communication and listening skills required.

Ability to handle multiple priorities is required.

Must be able to track, respond, trend, and multitask within the practice management system.

Knowledge of windows-based personal computers is required and experience with electronic claims editing software preferred.

Thorough knowledge of patient accounting, third party payer procedures, governmental regulations and managed care contracting to be effectively proactive in the billing and collection process, and to respond to inquiries on patient accounts in a customer satisfaction manner.

Education

Pay Range

At Lurie Children’s, we are committed to competitive and fair compensation aligned with market rates and internal equity, reflecting individual contributions, experience, and expertise. The pay range for this job indicates minimum and maximum targets for the position. Ranges are regularly reviewed to stay aligned with market conditions. In addition to base salary, Lurie Children’s offer a comprehensive rewards package that may include differentials for some hourly employees, leadership incentives for select roles, health and retirement benefits, and wellbeing programs. For more details on other compensation, consult your recruiter or click the following link to learn more about our benefits.

Benefit Statement

For full time and part time employees who work 20 or more hours per week we offer a generous benefits package that includes:

Medical, dental and vision insurance

Employer paid group term life and disability

Employer contribution toward Health Savings Account

Flexible Spending Accounts

Paid Time Off (PTO), Paid Holidays and Paid Parental Leave

403(b) with a 5% employer match

Various voluntary benefits:

Supplemental Life, AD&D and Disability

Critical Illness, Accident and Hospital Indemnity coverage

Tuition assistance

Student loan servicing and support

Adoption benefits

Backup Childcare and Eldercare

Employee Assistance Program, and other specialized behavioral health services and resources for employees and family members

Discount on services at Lurie Children’s facilities

Discount purchasing program

There’s a Place for You with Us

At Lurie Children’s we embrace and celebrate diversity and equity in a serious way. We are committed to building a team with a variety of backgrounds, skills, and viewpoints — recognizing that diverse identities strengthen our workplace and the care we can provide to the Chicago community and beyond. We treat everyone fairly, appreciate differences, and make meaningful connections that foster belonging and allyship. This is a place where you can be your best, so we can give our best to the patients and families who trust us with their care.  

Lurie Children’s and its affiliates are equal employment opportunity employers.  We value diversity and are committed to creating an inclusive environment for all employees.  All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity or expression, religion, national origin, ancestry, age, disability, marital status, pregnancy, protected veteran status, order of protection status, protected genetic information, or any other characteristic protected by law.

Support email: candidatesupport@luriechildrens.org