Patient Accounting Specialist Sr - Physician Billing

INTEGRIS Health; Oklahoma; On-site; USD 65,000 - 90,000; Full time

Job summary

INTEGRIS Health, Oklahoma's largest not-for-profit health system, seeks a Patient Accounting Specialist Sr - Physician Billing to join the Oklahoma City team. The role handles complex claims, payer audits, and denial management across physician billing while maintaining payer relationships and ensuring accurate submission of claims.

The ideal candidate has 4+ years in healthcare billing/denials, familiarity with DRG/ICD-10/CPT-4, and a Bachelor’s degree or relevant certifications.

Qualifications

• Four years experience in healthcare billing, collections, payment processing, or denials management (denials management experience preferred)
• Understands or has worked in 3+ areas of healthcare such as billing and collections and denials or registration and billing and collections preferred
• Healthcare certification (CRCR, CRCS, CHAA) preferred
• Bachelor’s Degree preferred
• Experience with DRG, ICD-10, CPT-4 and UB04/CMS-1500 claim billing
• Knowledge of legal documents and collection procedures
• Experience with hospital billing and reimbursement systems

Responsibilities

• Process complex transactions including global transplant cases and payer withholds
• Review and resolve denied/underpaid/overpaid claims and conduct appeals
• Maintain payer relationships and respond to inquiries and audits
• Audit and track payer files, update documentation as needed
• Prepare and submit required reports
• Collaborate with internal departments and IT to improve processes
• Stay informed on regulations and compliance requirements
• Communicate clearly with stakeholders and management

Skills

Healthcare billing

Denials management

Payer audits

Communication in English

Team collaboration

Education

Bachelor's degree

Healthcare certifications preferred

Tools

Microsoft Office

Billing software

Job description

Job Description

Join our team as a Patient Accounting Specialist Sr - Physician Billing at the INTEGRIS Health 5300 Building, in Oklahoma City, OK.

Get to Know Your Team

• INTEGRIS Health, Oklahoma's largest not-for-profit health system, is seeking a dedicated caregiver to join us in our mission to partner with people to live healthier lives.
• Benefits of being an INTEGRIS Health caregiver include front-loaded PTO, medical benefits through the extensive INTEGRIS Health network, financial assistance for continued education, 24/7 mental health support and more.
• Take your first step toward growing your career by joining us.
  

Responsibilities

The Patient Accounting Specialist III is responsible for processing complex transactions such as complex services such as global transplant cases, payer audits, payer withholds and managing complex data from multiple sources; reviewing and resolving denied and underpaid/overpaid claims and carrying out the appeals process. Works to maintain third-party payer relationships, including responding to inquiries, complaints, and other correspondence related to denials, appeals/ payments and audits. Superior understanding of claims management including provider level benefits, third party payer guidelines and contracts, state/federal laws and all other functions of the job. Maintains and monitors integrity of the claim development and submission process.

The Patient Accounting Specialist III responsibilities include, but are not limited to, the following:

• Responsible for importing and processing of payment files, claim processing, collection of insurance, and/or physician charge entry
• Executes the auditing, denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party and government payers in a timely manner.
• Monitors payer files for accuracy, ensures payer documentation is completed and assist in updating files with pertinent information as necessary.
• Conducts relevant research to assist with resolving files or claims and to stay informed on best practices and policy reforms.
• Conducts internal and external correspondence accurately, clearly, concisely, and professionally while following organizational regulations.
• Works with internal departments and external organizations to resolve complex accounts.
• Maintains data for trending purposes on payer issues, underpayments, banking errors, payment trends and collaborates with team members to make recommendations for improvements and resolving issues.
• Prepares, maintains, assist with, and submits reports as required.
• Regularly makes complex decisions within the scope of the position, and is comfortable working independently.
• Collaborates with team members to continually improve services, and engages in process and quality improvement activities. Provides feedback to management on revenue opportunities and payer standards.
• Maintains thorough knowledge and can communicate effectively state and federal regulations, accreditation/compliance requirements, and INTEGRIS Health policies, including those regarding fraud and abuse, confidentiality, and HIPAA.
• Pinpoints improvement opportunities and contributes to the testing of system modifications; works closely with IT staff and department managers to ensure proper implementation.
• Participates in professional development to enhance job knowledge and performance.
• Conducts relevant research to assist with completing the appeals process and to stay informed on best practices and policy reforms.

Reports to the manager or supervisor of the department as assigned.

This position may have additional or varied physical demand and/or respiratory fit test requirements. Please consult the Physical Demands Project SharePoint site or contact Risk Management/Employee Health for additional information.

Potential for exposure to infections and communicable diseases, blood and body fluids, electrical equipment, chemicals. Must follow standard precautions.

Qualifications

• Four years experience in healthcare billing, collections, payment processing, or denials management (denials management experience preferred)
• Understands or has worked in 3+ areas of healthcare such as billing and collections and denials or registration and billing and collections preferred
• Healthcare certification (CRCR, CRCS, CHAA) preferred
• Bachelors Degree preferred
• Previous experience in DRG, ICD-10, CPT-4 and UB04/CMS-1500 claim billing
• Knowledge of legal documents, contract documents, and collection agency procedures and legal procedures
• Previous experience in Microsoft Office and experience with billing and claims management software
• Previous experience with hospital billing and reimbursement, physician billing and reimbursement, Medicare and Medicaid denials and appeals, commercial payer denials and appeals, third-party contracts, NCQA guidelines for denials and appeals, Federal and State regulations relating to denials and appeal and Fair Debt Collection Practices
• Must be able to communicate effectively in English (verbal/written)

INTEGRIS Health is an Equal Opportunity Employer. All applicants will receive consideration regardless of membership in any protected status as defined by applicable state or federal law, including protected veteran or disability status.

About Us

INTEGRIS Health mission: Partnering with people to live healthier lives.

To our patients, that means we will partner to provide unprecedented access to quality and compassionate health care. To you, it means some of the state's best career and development opportunities. With INTEGRIS Health, you will have a genuine chance to make a difference in your life and your career.

INTEGRIS Health is the state's largest Oklahoma-owned health system with hospitals, rehabilitation centers, physician clinics, mental health facilities and home health agencies throughout much of the state.