PN Account Specialist II

Cook Children's Medical Center; Fort Worth (TX); On-site; USD 52,000 - 74,000; Full time

Job summary

Cook Children's Medical Center is seeking an Account Specialist II focused on Insurance Follow-Up & Denials Management. You will handle insurance follow-up, denial resolution, and appeals for CCPN providers, delivering timely analyses and adjustments while maintaining professional patient interactions.

The role requires solid experience in physician billing, knowledge of managed care denials, and strong communication skills.

Qualifications

• High School or equivalent required.
• At least 3 years experience in a physician billing environment or 2+ years as PN Account Specialist I with Meets Expectations rating.
• 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 coding knowledge and medical terminology; broad health plan understanding.
• Prior experience with Epic Resolute Professional Billing preferred.

Responsibilities

• Follow up, analyze, and resolve outstanding insurance claims; initiate appeals when needed.
• Provide reimbursement analysis and timely financial/volume data related to claims adjudication.
• Perform patient account adjustments and maintain proper documentation.
• Provide feedback on coding effectiveness to practice managers.
• Monitor active accounts receivable to identify potential problems.
• Serve as liaison between assigned practices and the billing office; communicate with patients and providers.

Skills

High School diploma

Physician billing experience

Managed care contracts

Denials and payor methodology

Communication skills

Medical terminology

Coding concepts

Education

High School or equivalent

Tools

Epic Resolute Professional Billing

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 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.