Medical Billing Specialist

Owensboro Pediatrics; Kentucky; Hybrid; USD 42,000 - 56,000; Full time

Job summary

Owensboro Pediatrics is seeking a Patient Account Representative II to join our revenue cycle team. The role focuses on denials management, appeals preparation, and collaboration with billing, coding, and clinical staff to expedite resolutions.

Ideal candidates have 2 years in claims processing and denials, plus 1 year with EPIC EMR, and possess strong attention to detail and communication skills to ensure compliant submissions.

Qualifications

• 2 years of current experience in claims processing and denials management.
• 1 year of current experience with EPIC.
• Recent experience working with the EPIC EMR system.

Responsibilities

• Analyze denials and determine the best course of action for appeal or resubmission.
• Prepare and submit accurate and compliant appeals for denied claims.
• Collaborate with billing, coding, and clinical staff to gather necessary information for appeals and resolve denial issues efficiently.
• Maintain detailed records of denial cases, including appeals filed and communications with insurance representatives.
• Monitor the status of appealed claims and follow up with insurance representatives to expedite resolution.
• Generate and analyze reports on denial trends, identify root causes, and recommend process improvements.

Skills

Denials analysis

Communication skills

Attention to detail

Collaboration

Appeals process knowledge

Education

High school diploma or equivalent

Tools

EPIC EMR

Job description

Job Description

Position Overview. We are looking for a detail-oriented and experienced Patient Account Representative II to join our team. If you have a strong understanding of Revenue Cycle Management processes, especially in handling denials and appeals, we would love to hear from you.

Key Responsibilities

• Analyze denials and determine the best course of action for appeal or resubmission.
• Prepare and submit accurate and compliant appeals for denied claims.
• Collaborate with billing, coding, and clinical staff to gather necessary information for appeals and resolve denial issues efficiently.
• Maintain detailed records of denial cases, including appeals filed and communications with insurance representatives.
• Monitor the status of appealed claims and follow up with insurance representatives to expedite resolution.
• Generate and analyze reports on denial trends, identify root causes, and recommend process improvements.

Qualifications

• High school diploma or equivalent.
• 2 years of current experience in claims processing and denials management.
• 1 year of current experience with EPIC.
• Recent experience working with the EPIC EMR system.

Required Skills

• Ability to analyze denial reasons, identify trends, and develop strategies to minimize denials.
• Excellent written and verbal communication skills for effective communication with internal staff and insurance representatives.
• Strong attention to detail and accuracy in documentation and appeals submissions.
• Ability to collaborate effectively with multidisciplinary teams to achieve common goals.
• Thorough understanding of billing regulations, coverage guidelines, and the appeals process.

Physical Requirements

• Sitting: 90%
• Standing/Walking: 10%
• Occasional lifting/carrying of supplies and paper weighing up to 40 pounds.
• Occasional pushing/pulling to move supplies and equipment.
• Occasional climbing of stairs to reach other levels of the building.
• Occasional stooping/kneeling/bending/crouching to file in low cabinets, purge old bills, and print forms.
• Occasional reaching/handling/fingering to complete paperwork, use computers, file, and answer telephones.
• Frequent talking/hearing/seeing to interact with staff and customers to complete assigned tasks.

Environmental Conditions

Inside Location: Onsite or Remote