Accounts Resolution Specialist I

Doylestown Health; Philadelphia (Philadelphia County); Ibrido; USD 28.000 - 34.000; Tempo pieno

Descrizione del lavoro

Penn Medicine Dermatology, located at 3535 Market Street in Philadelphia, seeks an Account Resolution Specialist I for hybrid work hours (M–F, 8:00 AM–4:30 PM; one in-office Tuesday – mandatory). The role focuses on resolving claim edits and denials, with attention to Medicare/Medicaid guidelines.

Qualifications include a High School Diploma or GED and 3+ years in health care billing. Penn Medicine emphasizes equal opportunity employment and comprehensive benefits for employees.

Competenze

• 3+ years in health care billing
• Experience with claim edits and denials
• Ability to investigate denials and appeal
• Knowledge of Medicare/Medicaid guidelines

Mansioni

• Review and resolve patient accounts in the claim edit and follow-up queues.
• Investigate denials and underpayments; pursue payer appeals or adjustments.
• Escalate denial trends and root causes to reduce future denials.
• Ensure billing standards align with Medicare, Medicaid and payer guidelines.
• Respond to patient inquiries regarding accounts and payments.
• Support the billing Supervisor and team with process improvements.

Conoscenze

Healthcare billing

Patient account research

Denials management

Formazione

HS Diploma or GED

Descrizione del lavoro

Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines. Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Entity: Clinical Practices of the University of Pennsylvania (CPUP)

Department: Dermatology

Location: 3535 Market Street

Hours:M - F 8AM - 4:30pm (Hybrid - one day in the office (Tuesdays - mandatory)

Summary:

The Account Resolution Specialist I reports to the Supervisor of Billing; primary responsibilities are to facilitate activities necessary to a successful resolution of accounts. This position will work out of assigned work queues handling claim edit work queue resolution as well as follow up work queue denials transferred from Professional Billing Office that require department intervention. Individuals will be responsible for investigating claim denials and underpayments by insurance carriers and appeal for payment or make appropriate adjustment. Exercising good judgement in escalating identified denial trends or root cause of denials to mitigate future denials, expedite the reprocessing of claims and maximize opportunities to enhance front end claim edits to facilitate a first pass resolution.

Accountabilities:

• Responsible for patient account research in relation to working accounts within the claim edit work queue and follow-up work queue
• Identifying untimely accounts and performing accurate and timely write offs adhering to policy guidelines
• Responsible for maintaining the highest level of billing standards following current guidelines from Medicare, Medicaid, and other insurance entities.
• Answering revenue cycle patient inquiries as well as front desk questions regarding patient accounts
• Meets or exceeds established performance targets (productivity and quality) established by the Supervisor of Billing
• Performs duties in accordance with Penn Medicine and entity values, policies, and procedures
• Other duties as assigned to support the unit, department, entity, and health system organization

Education/Experience:

Required H.S. Diploma/GED 3+ years Working in health care (professional) billing, health insurance or equivalent

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.