PN Account Specialist

cookchildrens; Fort Worth (TX); On-site; USD 45,000 - 60,000; Full time

Job summary

Cook Children’s is seeking an Account Specialist, Insurance Follow-Up & Denials Management, to manage outstanding claims for CCPN providers. You will navigate payor portals, contact representatives to determine claim status, and initiate appeals when needed, while maintaining careful documentation and a professional, compassionate approach.

The role requires a high school diploma and three years in a business office, with a plus for knowledge of medical coding and diversified health

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

• Responsible for initial contact regarding outstanding claims for CCPN providers.
• Perform claims workqueue management and navigate payor websites.
• Contact claim representatives to determine the status of outstanding insurance claims.
• Initiate the appeals process on behalf of CCPN providers and maintain documentation.

Skills

Business office experience

Medical terminology

Health insurance payor knowledge

Denials and appeals process

Education

High School Diploma

Job description

Location:

Calmont Operations Building

Department:

CBO/PT Financial Services

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

The Account Specialist, Insurance Follow-Up & Denials Management is responsible for initial contact regarding outstanding claims for Cook Childrens Physician Network providers. Primary duties include; Claims workqueue 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.

Education:

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.

Certification/Licensure:

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.