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Epic Claims Specialist- Support Services Building
Prevea Health
Prevea Health
To Apply, please click on the button below and put 19-416 in the "What" box then select "Search For Jobs"

Job Location: De Pere, WI
Job Type: Full-time

Epic Claims Specialist- Support Services Building


Job Description and Essential Functions

Job Title/Position: Claims Specialist

Job Classification: Administrative/Professional Support

Date of Analysis: 6/26/2013 Date of Revision/Review: 5/19/2015, 06/2018


Brief Description of Job Responsibilities:

Create and maintain claim and electronic remittance advice formats for insurance billing.

  1. Create and maintain claim formats (paper and electronic) for billing insurance companies.
  2. Work with insurance companies to meet their billing requirements.
  3. Create and maintain claim edit work queues.
  4. Build rules for claim edit work queues.
  5. Work with credentialing staff regarding required provider numbers and group numbers for insurance billing.
  6. Create and maintain provider number and group number formats for insurance billing.
  7. Create and maintain other claim related master files.
  8. Test upgrade changes for claims, remits, and claim edit work queues.
  9. Create and maintain electronic remittance posting.
  10. Maintain ANSI code mapping for electronic and manual payment posting.
  11. Contact person for Epic regarding claims and remit issues.
  12. Create and maintain training documentation for Epic claims and electronic remits.
  13. Create and maintain separate service area claim formats and electronic remits.
  14. Perform daily claim duties, printing, transmitting, and balancing.
  15. Create and maintain Flexsys claim formats for optical supply billing.
  16. Generate claim forms for bad debt balances.
  17. Complete assigned work queues.

Specialized Responsibilities:

Performance Requirements:

  1. Epic experience
  2. Ability to work independently while performing responsibilities efficiently and accurately.
  3. Strong investigative skills.
  4. Computer experience and 10 key proficiency.
  5. Excellent organizational skills.
  6. Excellent communications skills with internal and external customers.
  7. Knowledge of CPT/ICD-10 and ANSI codes.
  8. Word processing and computer experience with Excel, Word and Windows based applications.
  9. Detail oriented.
  10. Knowledge of insurance billing requirements.
  11. Medical terminology.
  12. Respect confidentiality of all patients.


  1. Two years experience with medical insurance billing.
  2. Knowledge of Medicare, Medical Assistance, and other third party payers.
  3. Knowledge of CPT/ICD-10, ANSI codes.
  4. Knowledge of claim filing requirements.

Non-Essential Duties: Other duties as assigned within scope of practice

Typical Working Conditions:

Normal office environment with sitting for long periods of time. May be required to stoop, bend, and stretch for filing purposes. Requires manual dexterity functionality for the use of a computer, telephone, fax, or copy machine. Often in contact with insurance companies.

Typical Physical Demands:

Requires sitting for long periods of time. Working in office environment. Some bending and stretching required. Working under stressful conditions and able to problem solve. Use of telephone, copier and fax machine required. Manual dexterity required for use of calculator, and computer keyboard. Ability to lift up to 30 pounds. Requires corrected vision to 20/30 and hearing to normal range.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United State and to complete the required employment eligibility document form upon hire. Prevea participates in E-verify. To learn more about E-Verify, including your rights and responsibilities, please visit Opens in New Window

Essential Functions/Physical Demands

Job Title/Position: Claims Specialist

Job Classification: Administrative/Professional Support

How to Apply:
We have over 1200 reasons for you to consider a career with Prevea Health--they're our employees. We're an organization that values teamwork and provides continuous education, training and support so every member of the team contributes to our success. We offer a competitive salary and benefits package in an environment geared to professional and personal growth. No matter what your background or professional interests are, we think you'll like what we have to offer. Together we are the best place to get care and the best place to give care.

To Apply, please click on the button below and put 19-416 in the "What" box then select "Search For Jobs"

Prevea Health

Prevea Health is an Equal Employment Opportunity/Affirmative Action employer.

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