Insurance Claims Follow-up
About The Position
The Account Specialist II / Insurance Claims Follow-up is primarily responsible for all insurance follow-up responsibilities for the Cook Children's Physician Network. Primary duties include follow-up, analysis, and resolution of outstanding insurance claims, and initiation of the appeals process on behalf of CCPN providers. Will perform duties such as reimbursement analysis; providing updates to 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 the effectiveness of diagnostic and procedural coding; monitors active accounts receivable for identification of potential problems; serves as a 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. Note: This is a remote position but will require 1-2 weeks of training in Fort Worth (candidates must live in Texas).
Requirements
- High School or equivalent required.
- At least 3 years' experience in a physician billing environment ( or) at least two (2) years working as an Account Specialist I with Cook Children's with a satisfactory performance record.
- Intermediate knowledge of coding and medical terminology.
- Extensive knowledge of healthcare third-party reimbursement, variance and denial records.
- Effective oral and written communication skills.
Nice To Haves
- Strong understanding of diversified health insurance plans a plus.
- Experience with managed care contracts, denials and payor methodology.
- Prior experience with Epic Resolute Professional Billing preferred.
Responsibilities
- Follow-up, analysis, and resolution of outstanding insurance claims
- Initiation of the appeals process on behalf of CCPN providers
- Reimbursement analysis
- Providing updates to the Manager, Insurance Follow-Up & Denials Management with timely financial and volume data related to claims adjudication and payment trend analyses
- Performing all required patient account adjustments
- Providing feedback to practice managers regarding the effectiveness of diagnostic and procedural coding
- Monitoring active accounts receivable for identification of potential problems
- Serving as a liaison between assigned practice(s) and billing office
- Communicating effectively with patients, practice managers, physicians and others regarding collection of outstanding claims
- Maintaining proper documentation and edits of work performed
- Maintaining a professional demeanor to assure that patients are treated in an appropriate and compassionate manner
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
