Account Service Representative I – Claim Edit Representative

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

680 Lake Shore Drive

Job Description

Schedule: Hybrid

The Account Service Representative I – Claim Edit Representative is responsible for reviewing, analyzing, and resolving claim edits within the Epic work queue system to ensure timely and accurate claim submission for professional services. This role plays a vital part in the revenue cycle by identifying and correcting billing errors, coordinating with internal departments to resolve coding and registration issues, and maintaining compliance with payer and regulatory requirements.

Key Responsibilities:

• Review and resolve professional billing claim edits and charge review work queues in Epic.
• Ensure claims comply with payer-specific billing guidelines and regulations.
• Communicate and collaborate with coding, registration, and clinical departments to resolve claim errors or missing information.
• Identify recurring issues and escalate trends to management for process improvement and payer escalation.
• Utilize Epic’s real-time eligibility and payer tools to validate insurance data and benefits.
• Work denials related to claim edits when necessary, ensuring proper documentation and timely follow-up.
• Maintain documentation of all actions taken on accounts in accordance with department policies.
• Assist in maintaining edit resolution workflows and reference materials.
• Stay up to date on billing regulations, payer guidelines, and Epic system updates.
• Meet productivity and quality standards as defined by department leadership.

Education and Skills:

• High school graduate required; physician or hospital billing experience and/or training, BS or BA preferred.
• Knowledge of ICD-10 coding, medical terminology, third party billing and collections, required.
• EPIC experience preferred.
• Excellent communication and listening skills
• Problem solving ability and able to handle multiple priorities.
• Knowledge of windows-based personal computers is required and experience with electronic claims editing software preferred.
• Demonstrates effective utilization of the features of the telephone system in order to achieve greater productivity with appropriate collection practices and techniques.
• 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

High School Diploma/GED (Required)

Pay Range

$19.50-$30.23 Hourly

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