PN Account Specialist II
About The Position
The Account Specialist II, Insurance Follow-Up & Denials Management is responsible for all insurance follow-up responsibilities for Cook Childrens 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.
Requirements
- High School or equivalent required
- Intermediate knowledge of coding and medical terminology with understanding of diversified health insurance plans a plus
- 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
Nice To Haves
- Medical terminology preferred
- 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
- 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
- maintains 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
