PN Account Specialist II

Cook Children's Health Care System • Fort Worth, TX

1d

About The Position

The Account Specialist II, Insurance Follow-Up & Denials Management is responsible for insurance follow-up for Cook Children’s Physician Network. The role follows up on, analyzes, and resolves outstanding insurance claims and initiates appeals on behalf of CCPN providers. It also includes reimbursement analysis, supplying the Manager, Insurance Follow-Up & Denials Management with timely financial and volume data on claims adjudication and payment trends, and completing required patient account adjustments. The specialist provides practice managers with feedback on diagnostic and procedural coding effectiveness, monitors active accounts receivable for potential problems, and serves as a liaison between assigned practices and the billing office. The role communicates with patients, practice managers, physicians, and others about outstanding claims, maintains accurate documentation and work edits, and treats patients professionally and compassionately.

Requirements

• High school diploma or equivalent.
• At least 3 years of experience in a physician billing environment, or at least 2 years as a PN Account Specialist I with proficiency 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.

Nice To Haves

• Medical terminology.
• Intermediate knowledge of coding and medical terminology, and understanding of diversified health insurance plans.
• Prior experience with Epic Resolute Professional Billing.

Responsibilities

• Follow up on, analyze, and resolve outstanding insurance claims.
• Initiate the appeals process on behalf of CCPN providers.
• Conduct reimbursement analysis.
• Provide the Manager, Insurance Follow-Up & Denials Management with timely financial and volume data related to claims adjudication and payment trend analyses.
• Perform required patient account adjustments.
• Provide practice managers with feedback regarding the effectiveness of diagnostic and procedural coding.
• Monitor active accounts receivable to identify potential problems.
• Serve as a liaison between assigned practices and the billing office.
• Communicate with patients, practice managers, physicians, and others regarding collection of outstanding claims.
• Maintain proper documentation and edits of work performed.
• Maintain a professional demeanor and ensure patients are treated appropriately and compassionately.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED