Top 43 claims representative Jobs in milwaukee wi

Director of Revenue Cycle
Outreach Community Health Centers —Milwaukee, WI
- Management
- Writing skills
- Bachelor's degree
- Dental insurance
- Employee discount
Quick Apply
Account Resolution Representative
Children's Wisconsin —West Allis, WI
- Full-time
- Remote
- Anatomy knowledge
- HIPAA
- Research
- Flexible schedule
Patient Access Liaison - UPLIZNA - Milwaukee, WI
Amgen —Milwaukee, WI
- $158,394 - $185,578 a year
- Weekends as needed
- Doctoral degree
- HIPAA
- Mid-level
- Disability insurance
- Health insurance
Account Rep Ld Follow-up
Children's Wisconsin —West Allis, WI
- Full-time
- Remote
- Bilingual
- Mid-level
- Finance
7d
Commercial Banking Client Representative
U.S. Bank National Association —Brookfield, WI
- $24.18 - $32.21 an hour
- Multiple hires
- Hybrid work
- Mid-level
- 3 years
- Analysis skills
- Paid holidays
- Disability insurance
Account Resolution Representative Senior
Children's Wisconsin —West Allis, WI
- Full-time
- Bilingual
- Research
- Mid-level
Member Service Representative- Dental
Dental Associates Ltd —Wauwatosa, WI
- Full-time
- Hybrid work
- Mid-level
- Office
- High school diploma or GED
- Health savings account
- Paid holidays
Quick Apply
Customer Service Representative
Allstate Insurance Agency - David Kelley —Milwaukee, WI
- $55,000 - $80,000 a year
- Full-time
- Computer literacy
- Office
- High school diploma or GED
- Paid training
- 401(k)
Quick Apply
Property Field Claims Adjuster Sr- Milwaukee, Wisconsin
COUNTRY Financial —Milwaukee, WI
- $77,600 - $106,700 a year
- Full-time
- Remote
- 7 years
- Senior level
- Disability insurance
- Health insurance
Representative, Health Plan Provider Relations ( Wisconsin long-term services and supports (LTSS) Provider Quality; must reside in Wisconsin)
Molina Healthcare —Milwaukee, WI
- $19.84 - $38.69 an hour
- Full-time
- Medical office experience
- Mid-level
- Residential
- Health insurance
Property Damage Claims Representative
Hupy and Abraham S C —Milwaukee, WI
- $21 an hour
- Full-time
- Microsoft Outlook
- Word processing
- Mid-level
- Paid holidays
- Disability insurance
Quick Apply
3d
Billing Insurance Follow-up
Sixteenth Street Community Health Centers —Milwaukee, WI
- Full-time
- Computer literacy
- English
- Mid-level
Quick Apply
Account Rep II, HMO - Clinical Practice Services
The Medical College of Wisconsin, Inc. —Wauwatosa, WI
- Full-time
- Hybrid work
- Mid-level
- High school diploma or GED
- Quality control
- Paid parental leave
- Paid holidays
Quick Apply
1d
Customer Service Representative - State Farm Agent Team Member
Laura Ashley - State Farm Agent —Milwaukee, WI
- $40,000 - $60,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- Paid time off
- Opportunities for advancement
Quick Apply
Customer Support Representative
Engine and Transmission Exchange —Brown Deer, WI
- Hybrid work
- Computer literacy
- Writing skills
- Experience equivalent to degree accepted
Quick Apply
Inside Sales and Customer Service Representative
Zepole Restaurant Supply Co. —Milwaukee, WI
- $20 - $30 an hour
- Full-time
- Computer literacy
- Merchandising
- ERP systems
- Health insurance
- Dental insurance
Quick Apply
3d
Account Representative
Brown & Brown Insurance —Milwaukee, WI
- Full-time
- Mid-level
- Office
- Business development
- Employee stock purchase plan
- Paid holidays
Senior Field Claim Representative
Germantown Mutual Insurance Company —Germantown, WI
- $70,000 - $90,000 a year
- Full-time
- Hybrid work
- 7 years
- Customer service
- Administrative experience
- Profit sharing
- Paid holidays
Quick Apply
Customer Service Representative - State Farm Agent Team Member
Joe Tamm - State Farm Agent —Greenfield, WI
- $40,000 - $55,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- 401(k)
- Paid time off
Quick Apply
Claims Manager
OPERATING ENGINEERS LOCAL 139 HEALTH FUND —Pewaukee, WI
- $85,000 a year
- Overtime
- Management
- Research
- Mid-level
- Paid holidays
- Disability insurance
Quick Apply

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Director of Revenue Cycle

Outreach Community Health Centers -
Milwaukee, WI

Quick Apply

Job Details

Benefits

Dental insurance
Employee discount

Qualifications

Staff supervision
Management
Healthcare staff management
Medicare
Writing skills
Health insurance knowledge
Medicare regulations
Centers for Medicare and Medicaid Services (CMS)
Centers for Medicare & Medicaid Services (CMS) billing regulations
Medicaid regulations
Medicaid

Full Job Description

Position Summary

Under the direction of the Chief Financial Officer (CFO), the Director of Revenue Cycle provides strategic and hands-on leadership for all FQHC revenue cycle operations. The role is directly responsible for closely monitoring accounts receivable, driving measurable improvements in collection rates, and implementing ongoing staff training to ensure billing compliance, denial reduction, and revenue optimization. The Director ensures integration between clinical operations, finance, billing vendors, and payers with deep focus on FQHC-specific requirements including Medicare/Medicaid cost reporting, sliding fee scale, and encounter data integrity. The position has direct supervisory oversight of the Patient Service Representative Supervisor and full responsibility for the Sliding Fee Discount Program and Provider Credentialing.

Supervisory Responsibilities

Directly supervises the Patient Service Representative (PSR) Supervisor.
Indirectly oversee PSR staff through the PSR Manager.
Responsible for performance management, training coordination, and accountability for registration, eligibility, and sliding fee processes.

Essential Duties and Responsibilities

The essential functions include, but are not limited to the following:

PROVIDER CREDENTIALING & ENROLLMENT

Manage and oversee the full lifecycle of provider credentialing and enrollment for all billable providers.
Ensure all providers are credentialed and enrolled with Medicare, Medicaid, and all commercial/managed care payers prior to their start date and maintained current thereafter.
Coordinate with HR and clinical leadership to onboard new providers, including completion of CAQH, state licenses, DEA, and payer applications.
Re-credential providers according to payer schedules (typically every 3 years) and ensure no lapse in reimbursement eligibility.
Investigate and resolve credentialing-related claim denials (e.g., provider not on file, non-participating status) in collaboration with billing staff.
Ensure timely submission of provider demographic changes (address, NPI, taxonomy practice location) to all payers.

ACCOUNTS RECEIVABLE – CLOSE MONITORING

Perform daily and weekly reviews of AR aging reports by payer (Medicare, Medicaid, Commercial, Self-Pay) and by service (medical, dental, behavioral health and case management).
Monitor days in accounts receivable (DAR), gross/net collection rates, and percentage of AR > days; present findings to CFO and department leadership.
Reconcile payer payments to contracts monthly, identifying underpayments, timely filing denials, precertification and pre-authorization denials, and FQHC-specific reimbursement shortfalls/
Oversee uncollectible account reviews and write-offs approvals in compliance with FQHC sliding scale fee scales policies.

IMPROVING COLLECTION RATES

Develop and implement strategies to reduce self-pay AR through improved sliding fee scale determination at registration, payment plan options, and follow-up protocols.
Lead denial management efforts with a focus on top FQHC denial reasons (e.g., missing encounter data, incorrect place of service, missing sliding fee documentation, prior authorization gaps, timely filing).
Collaborate with the PSR Manager to reduce registration-related collection barriers (e.g., incomplete sliding fee application applications, inaccurate or missing insurance capture, missed self-pay collections at check-in).
Establish and monitor collection KPIs by provider, site, and payers.

SLIDING FEE DISCOUNT PROGRAM

Own and administer the organization's Sliding Fee Discount Program in compliance with HRSA FQHC requirements.
Develop, maintain, and annually update the Sliding Fee Scale Policy, discount tiers, and eligibility criteria.
Ensure all patients are screened for sling fee eligibility at registration and recertified annually.
Oversee the accurate processing of sliding fee application, income verification, and discount application withing the EMR.
Conduct quarterly internal audits of sliding fee determinations and discounts applied; correct errors and retained staff as needed.
Prepare for and support HRSA operational site visits (OSV) related to sliding fee compliance.
Report sliding fee program metrics (e.g., % of patients screened, % eligible, write-offs by discount levels) to CFO monthly.
Ensure sliding fee discounts are properly reflected in patient statements and AR write-offs.

TRAINING STAFF (ONGOING)

Develop and deliver a revenue cycle training curriculum for registration staff (PSRs), billers, and clinical providers, including:
FQHC billing rules
Sliding fee scale – application, documentation, patient communication, and compliance
Medicare/Medicaid compliance and cost report data capture
Denial root cause analysis and prevention strategies
EMR workflows for charge capture, encounter closure, and registration accuracy
Provide real-time coaching on denied claims and registration errors; maintain a denial log with assigned corrective training for recurring issues.

ADDITIONAL FQHC-SPECIFIC DUTIES

Ensure accurate encounter data submission for Medicare/Medicaid cost reports and UDS reporting.
Monitor regulatory changes (Medicare Physician Fee Schedule, Medicaid FQHC PPS, FQHC billing manual, HRSA sliding guidance) and update internal policies/training accordingly.
Coordinate with clinical departments to optimize EMR workflows for same-day encounter closure, coding accuracy, and reduction of pre-bill edits.
Investigate denials trends, communication root cause owners (e.g., registration/PSR Supervisor and clinical), and report findings to leadership.
Assist providers on documentation rules tied to reimbursement (e.g., medical necessity, qualifying visit criteria for FQHC encounter rate).

LEADERSHIP & ADMINISTRATION

Attend staff meetings, leadership meetings, external FQHC revenue cycle collaborative sessions and EMR billing meetings.
Complete special projections as assigned by the CFO.

Minimum Qualifications (Knowledge, Skills, and Abilities)
Position requires the minimum of Bachelor's degree in Business Administration, Healthcare
Administration or related field preferred. Minimum 3-5 years of healthcare reimbursement experience, with at least 2 years in an FQHC, community health center, or rural health clinic (required). Minimum 3 years of experience with Medicare, Medicaid, and managed care billing in FQHC setting. Minimum 2-3 years of supervisory experience in revenue cycle, billing, or patient financial services. Knowledge of managed care policies. ICD10, and medical terminology preferred. Ability to read, write and communicate effectively orally and in writing.

Outreach Community Health Centers, Inc. is an Equal Opportunity Employer

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Refine Your Search

claims representative jobs in milwaukee wi

Director of Revenue Cycle

Account Resolution Representative

Patient Access Liaison - UPLIZNA - Milwaukee, WI

Account Rep Ld Follow-up

Commercial Banking Client Representative

Account Resolution Representative Senior

Member Service Representative- Dental

Customer Service Representative

Property Field Claims Adjuster Sr- Milwaukee, Wisconsin

Representative, Health Plan Provider Relations ( Wisconsin long-term services and supports (LTSS) Provider Quality; must reside in Wisconsin)

Property Damage Claims Representative

Billing Insurance Follow-up

Account Rep II, HMO - Clinical Practice Services

Customer Service Representative - State Farm Agent Team Member

Customer Support Representative

Inside Sales and Customer Service Representative

Account Representative

Senior Field Claim Representative

Customer Service Representative - State Farm Agent Team Member

Claims Manager

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