Patient Accounting Spec Sr

INTEGRIS Health•OK, OK

8d•Onsite

About The Position

The Patient Accounting Specialist III processes complex transactions, including global transplant cases, payer audits, payer withholds, and complex data from multiple sources. The role reviews and resolves denied, underpaid, and overpaid claims and carries out the appeals process. It maintains third-party payer relationships by responding to inquiries, complaints, and correspondence related to denials, appeals, payments, and audits. The position requires a superior understanding of claims management, provider-level benefits, third-party payer guidelines and contracts, state and federal laws, and related job functions. It also maintains and monitors the integrity of claim development and submission. This is a full-time day-shift position at INTEGRIS Health Corporate in Oklahoma City, Oklahoma. The stated shift is 6 a.m. to 6 p.m. The position reports to the manager or supervisor of the department as assigned. It may involve additional or varied physical demands and/or respiratory fit-test requirements. Potential exposures include infections and communicable diseases, blood and body fluids, electrical equipment, and chemicals; standard precautions must be followed.

Requirements

Four years of experience in healthcare billing, collections, payment processing, or denials management; denials management experience is preferred.
Previous experience with DRG, ICD-10, CPT-4, and UB-04/CMS-1500 claim billing.
Knowledge of legal documents, contract documents, collection agency procedures, and legal procedures.
Previous experience with Microsoft Office and billing and claims management software.
Previous experience in hospital billing and reimbursement, physician billing and reimbursement, Medicare and Medicaid denials and appeals, commercial payer denials and appeals, third-party contracts, NCQA guidelines for denials and appeals, federal and state regulations relating to denials and appeals, and Fair Debt Collection Practices.
Ability to communicate effectively in English, verbally and in writing.
Must follow standard precautions given potential workplace exposure to infections and communicable diseases, blood and body fluids, electrical equipment, and chemicals.

Nice To Haves

Experience in three or more areas of healthcare, such as billing and collections, denials, or registration; experience across these areas is preferred.
Healthcare certification such as CRCR, CRCS, or CHAA preferred.
Bachelor's degree preferred.
Denials management experience preferred.

Responsibilities

Import and process payment files, process claims, collect insurance, and/or enter physician charges.
Execute the auditing and denial appeals process, including receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party and government payers in a timely manner.
Monitor payer files for accuracy, ensure payer documentation is completed, and assist in updating files with pertinent information.
Conduct research to help resolve files or claims and stay informed about best practices and policy reforms.
Conduct internal and external correspondence accurately, clearly, concisely, and professionally while following organizational regulations.
Work with internal departments and external organizations to resolve complex accounts.
Maintain data for trending payer issues, underpayments, banking errors, and payment trends; collaborate with team members on recommendations for improvements and issue resolution.
Prepare, maintain, assist with, and submit reports as required.
Make complex decisions within the scope of the position and work independently.
Collaborate with team members to improve services and participate in process and quality improvement activities; provide management with feedback on revenue opportunities and payer standards.
Maintain thorough knowledge of and communicate effectively about state and federal regulations, accreditation and compliance requirements, and INTEGRIS Health policies, including those addressing fraud and abuse, confidentiality, and HIPAA.
Identify improvement opportunities and contribute to testing system modifications; work with IT staff and department managers to ensure proper implementation.
Participate in professional development to enhance job knowledge and performance.
Research matters relevant to completing the appeals process and staying informed about best practices and policy reforms.