Patient Accounting Specialist Sr - Physician Billing

INTEGRIS Health•OK, OK

12h•Onsite

About The Position

Join our team as a Patient Accounting Specialist Sr - PB at the INTEGRIS Health 5300 Building in Oklahoma City, OK. This role is dedicated to Medicare and Medicare Advantage follow-up and denial resolution activities. INTEGRIS Health, Oklahoma's largest not-for-profit health system, is seeking a dedicated caregiver to join us in our mission to partner with people to live healthier lives. Take your first step toward growing your career by joining us.

Requirements

Four years experience in healthcare billing, collections, payment processing, or denials management (denials management experience preferred)
Understands or has worked in 3+ areas of healthcare such as billing and collections and denials or registration and billing and collections preferred
Previous experience in DRG, ICD-10, CPT-4 and UB04/CMS-1500 claim billing
Knowledge of legal documents, contract documents, and collection agency procedures and legal procedures
Previous experience in Microsoft Office and experience with billing and claims management software
Previous experience with 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 appeal and Fair Debt Collection Practices
Must be able to communicate effectively in English (verbal/written)

Nice To Haves

Healthcare certification (CRCR, CRCS, CHAA) preferred
Bachelors Degree preferred

Responsibilities

Processing complex transactions such as complex services like global transplant cases, payer audits, payer withholds and managing complex data from multiple sources.
Reviewing and resolving denied and underpaid/overpaid claims and carrying out the appeals process.
Maintaining third-party payer relationships, including responding to inquiries, complaints, and other correspondence related to denials, appeals/payments and audits.
Maintaining and monitoring the integrity of the claim development and submission process.
Importing and processing of payment files, claim processing, collection of insurance, and/or physician charge entry.
Executing the auditing, denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party and government payers in a timely manner.
Monitoring payer files for accuracy, ensuring payer documentation is completed and assisting in updating files with pertinent information as necessary.
Conducting relevant research to assist with resolving files or claims and to stay informed on best practices and policy reforms.
Conducting internal and external correspondence accurately, clearly, concisely, and professionally while following organizational regulations.
Working with internal departments and external organizations to resolve complex accounts.
Maintaining data for trending purposes on payer issues, underpayments, banking errors, payment trends and collaborating with team members to make recommendations for improvements and resolving issues.
Preparing, maintaining, assisting with, and submitting reports as required.
Making complex decisions within the scope of the position, and is comfortable working independently.
Collaborating with team members to continually improve services, and engaging in process and quality improvement activities.
Providing feedback to management on revenue opportunities and payer standards.
Maintaining thorough knowledge and ability to communicate effectively state and federal regulations, accreditation/compliance requirements, and INTEGRIS Health policies, including those regarding fraud and abuse, confidentiality, and HIPAA.
Pinpointing improvement opportunities and contributing to the testing of system modifications; working closely with IT staff and department managers to ensure proper implementation.
Participating in professional development to enhance job knowledge and performance.
Conducting relevant research to assist with completing the appeals process and to stay informed on best practices and policy reforms.