PN Account Specialist

CCPN Cook Children's Physician Network; United States; On-site; USD 42,000 - 56,000; Full time

Job summary

CCPN Cook Children's Physician Network is seeking an Account Specialist, Insurance Follow-Up & Denials Management to handle outstanding claims for CCPN providers. You will manage the claims queue, navigate payor websites, and contact claim representatives to determine status.

You will initiate appeals on behalf of CCPN providers, maintain proper documentation, and uphold a professional, compassionate demeanor with guests while ensuring timely resolution of denials.

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 is a plus.
• Medical terminology preferred.
• Proven track record of writing and submitting appeals to get claim denials overturned.
• Professional billing experience in a Pediatric environment preferred.
• Epic experience preferred.

Responsibilities

• Handle initial contact regarding outstanding claims for CCPN providers.
• Manage claims work queue and navigate payor websites.
• Contact claim representatives to determine status of outstanding insurance claims.
• Initiate appeals process on behalf of CCPN providers.
• Maintain proper documentation of work performed and interact professionally with guests.

Education

High School or equivalent

Tools

Epic

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 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.

Education & Experience

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. Proven track record of writing and submitting appeals to get claim denials overturned. Professional billing experience in a Pediatric environment preferred. Epic experience 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. Promise, a strong word with deep meaning that everyone understands—especially kids. This is the foundation of our organization and what drives us to blaze new trails in medical care, research, advanced technology, as well as programs and initiatives that benefit children who may not otherwise have access to quality health care. Every day our employees come to work with the intention of keeping our Promise. It's the guiding principle that helps our patients and their families get better and stay healthy. As a member of our Cook Children's team, you can be an important part of making that happen.