Insurance Follow-Up & Denials Management Specialist

Cook Children's Health Care System; Fort Worth (TX); On-site; USD 42,000 - 54,000; Full time

Job summary

Cook Children's Health Care System in Fort Worth, TX, seeks a Physician's Network Account Specialist to manage outstanding claims for CCPN providers. You will handle the claims work queue, navigate payor portals, and contact claim representatives to determine statuses while initiating appeals when needed.

You will maintain thorough documentation, uphold a professional, compassionate demeanor with guests, and collaborate with office staff to ensure accurate billing and timely resolutions.

Qualifications

• High School or equivalent required.
• Three years' experience in a business office setting is required.
• Basic knowledge of coding and medical terminology with understanding of diversified health insurance plans, managed care contracts, denials and payor methodology a plus.
• Medical terminology preferred.

Responsibilities

• Handle initial contact regarding outstanding claims for CCPN providers.
• Manage the claims work queue and navigate payor websites.
• Contact claim representatives to determine status of outstanding claims.
• Initiate appeals on behalf of CCPN providers.
• Maintain documentation of work performed and present a professional demeanor.

Skills

3 years' experience in a business offi

Medical terminology

Payor knowledge

Education

High School or equivalent

Job description

The Physician's Network Account Specialist is responsible for initial contact regarding outstanding claims for Cook Children's Physician Network providers. Primary duties include; Claims work queue management, navigating payor websites, contacting claim representatives to determine the status of outstanding insurance claims, initiation of the appeals process on behalf of CCPN providers, maintenance of proper documentation of work performed; and at all times maintain a professional demeanor to assure that guests are treated in an appropriate, professional and compassionate manner.

Qualifications:

• High School or equivalent required.
• Three years' experience in a business office setting is required.
• Basic knowledge of coding and medical terminology with understanding of diversified health insurance plans, managed care contracts, denials and payor methodology a plus.
• Medical terminology preferred.

About Cook Children's:

Our not-for-profit organization is comprised of a flagship medical center in Fort Worth, Texas, a new medical center in Prosper, Texas, a physician network, home health company, surgery centers, health plan, health services, and health foundation. With more than 60 primary, specialty and urgent care locations throughout Texas, families can access our top-ranked specialty programs and network of services to meet the unique needs of their child. Cook Children's is honored to continually receive recognition for our outstanding efforts and outcomes in pediatric health care.

At Cook Children's, we're more than a health care system-we're your friends, neighbors and even family members. And we're parents too, so we can see the world through your eyes. We see what you're going through-and how we can help you and your child get the best care and support possible.

Cook Children's is an equal opportunity employer. As such, Cook Children's offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination.

Cook Children's is a Texas-only employer. If you are hired, you will need to maintain your primary residence within the state of Texas, along with all licenses and credentials required for your position throughout your employment.