Insurance Denials & Follow-Up Specialist II

Cook Children's Health Care System; Fort Worth (TX); On-site; USD 52,000 - 68,000; Full time

Job summary

Cook Children’s Health Care System is seeking an Account Specialist II in Insurance Follow-Up & Denials Management to manage all insurance follow-up duties for CCPN. You will analyze and resolve outstanding claims, initiate appeals when needed, and provide timely financial data to support claims adjudication and payment trend analyses.

The role requires strong communication with practices, physicians and patients, monitoring accounts receivable, performing patient account adjustments, and

Qualifications

• High School or equivalent required.
• At least 3 years experience in a physician billing environment or at least two (2) years in the capacity of PN Account Specialist I, with proficiency in performance of duties evidenced by a minimum rating of meets expectations on the most recent Performance Review.
• Understanding of managed care contracts, denials and payor methodology.
• Extensive knowledge of healthcare third party reimbursement, variance and denial records.
• Effective oral and written communication skills.
• Medical terminology preferred.

Responsibilities

• Follow-up, analysis and resolution of outstanding insurance claims.
• Initiation of the appeals process on behalf of CCPN providers.
• Provide reimbursement analysis and timely financial data related to claims adjudication and payment trend analyses.
• Perform all required patient account adjustments.
• Provide feedback to practice managers regarding effectiveness of diagnostic and procedural coding.
• Monitor active accounts receivable for identification of potential problems.
• Serve as liaison between assigned practice(s) and billing office; communicate with patients, practice managers, physicians and others.

Skills

Oral and written communication

Medical terminology

Healthcare reimbursement knowledge

Denials management

Education

High School or equivalent

Tools

Epic Resolute Professional Billing

Job description

Cook Children’s Health Care System is seeking an Account Specialist II in Insurance Follow-Up & Denials Management to manage all insurance follow-up duties for CCPN. You will analyze and resolve outstanding claims, initiate appeals when needed, and provide timely financial data to support claims adjudication and payment trend analyses.

The role requires strong communication with practices, physicians and patients, monitoring accounts receivable, performing patient account adjustments, and