PN Account Specialist II

Cook Children's Health Care System; Fort Worth (TX); Presencial; USD 52 000 - 68 000; Tempo integral

Resumo da oferta

Cook Children’s Health Care System is seeking an Account Specialist II in Insurance Follow-Up & Denials Management to manage all insurance follow-up duties for CCPN. You will analyze and resolve outstanding claims, initiate appeals when needed, and provide timely financial data to support claims adjudication and payment trend analyses.

The role requires strong communication with practices, physicians and patients, monitoring accounts receivable, performing patient account adjustments, and

Qualificações

• High School or equivalent required.
• At least 3 years experience in a physician billing environment or at least two (2) years in the capacity of PN Account Specialist I, with proficiency in performance of duties evidenced by a minimum rating of meets expectations on the most recent Performance Review.
• Understanding of managed care contracts, denials and payor methodology.
• Extensive knowledge of healthcare third party reimbursement, variance and denial records.
• Effective oral and written communication skills.
• Medical terminology preferred.

Responsabilidades

• Follow-up, analysis and resolution of outstanding insurance claims.
• Initiation of the appeals process on behalf of CCPN providers.
• Provide reimbursement analysis and timely financial data related to claims adjudication and payment trend analyses.
• Perform all required patient account adjustments.
• Provide feedback to practice managers regarding effectiveness of diagnostic and procedural coding.
• Monitor active accounts receivable for identification of potential problems.
• Serve as liaison between assigned practice(s) and billing office; communicate with patients, practice managers, physicians and others.

Conhecimentos

Oral and written communication

Medical terminology

Healthcare reimbursement knowledge

Denials management

Formação académica

High School or equivalent

Ferramentas

Epic Resolute Professional Billing

Descrição da oferta de emprego

The Account Specialist II, Insurance Follow-Up & Denials Management is responsible for all insurance follow-up responsibilities for Cook Children’s Physician Network. Primary duties are; follow-up, analysis, and resolution of outstanding insurance claims; initiation of the appeals process on behalf of CCPN providers. The Account Specialist II, Insurance Follow-Up & Denials Management will primarily be responsible for performing duties such as; reimbursement analysis; provides the Manager, Insurance Follow-Up & Denials Management with timely financial and volume data related to claims adjudication and payment trend analyses; performs all required patient account adjustments; provides feedback to practice managers regarding effectiveness of diagnostic and procedural coding; monitors active accounts receivable for identification of potential problems; serves as liaison between assigned practice(s) and billing office; communicates effectively with patients, practice managers, physicians and others regarding collection of outstanding claims; maintains proper documentation and edits of work performed; and at all times maintains a professional demeanor to assure that patients are treated in an appropriate and compassionate manner.

Location:

Calmont Operations Building

Department:

CBO/PT Financial Services

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

The Account Specialist II, Insurance Follow-Up & Denials Management is responsible for all insurance follow-up responsibilities for Cook Children’s Physician Network. Primary duties are; follow-up, analysis, and resolution of outstanding insurance claims; initiation of the appeals process on behalf of CCPN providers. The Account Specialist II, Insurance Follow-Up & Denials Management will primarily be responsible for performing duties such as; reimbursement analysis; provides the Manager, Insurance Follow-Up & Denials Management with timely financial and volume data related to claims adjudication and payment trend analyses; performs all required patient account adjustments; provides feedback to practice managers regarding effectiveness of diagnostic and procedural coding; monitors active accounts receivable for identification of potential problems; serves as liaison between assigned practice(s) and billing office; communicates effectively with patients, practice managers, physicians and others regarding collection of outstanding claims; maintains proper documentation and edits of work performed; and at all times maintains a professional demeanor to assure that patients are treated in an appropriate and compassionate manner.

Qualifications:

• High School or equivalent required.
• At least 3 years experience in a physician billing environment or at least two (2) years in the capacity of PN Account Specialist I, with proficiency in performance of duties evidenced by a minimum rating of meets expectations on the most recent Performance Review.
• Understanding of managed care contracts, denials and payor methodology.
• Extensive knowledge of healthcare third party reimbursement, variance and denial records.
• Effective oral and written communication skills.
• Medical terminology preferred.
• Intermediate knowledge of coding and medical terminology with understanding of diversified health insurance plans a plus.
• Prior experience with Epic Resolute Professional Billing 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.