PN Account Specialist II

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

3d•Onsite

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. About Cook Children’s: Our not-for-profit organization is comprised of a flagship medical center in Fort Worth, Texas, a new medical center in Prosper, Texas, a physician network, home health company, surgery centers, health plan, health services, and health foundation. With more than 60 primary, specialty and urgent care locations throughout Texas, families can access our top-ranked specialty programs and network of services to meet the unique needs of their child. Cook Children's is honored to continually receive recognition for our outstanding efforts and outcomes in pediatric health care. At Cook Children's, we're more than a health care system––we're your friends, neighbors and even family members. And we're parents too, so we can see the world through your eyes. We see what you're going through––and how we can help you and your child get the best care and support possible. Cook Children’s is an equal opportunity employer. As such, Cook Children’s offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination. Promise, a strong word with deep meaning that everyone understands—especially kids. This is the foundation of our organization and what drives us to blaze new trails in medical care, research, advanced technology, as well as programs and initiatives that benefit children who may not otherwise have access to quality health care. Every day our employees come to work with the intention of keeping our Promise. It's the guiding principle that helps our patients and their families get better and stay healthy. As a member of our Cook Children's team, you can be an important part of making that happen. Please, create a profile and upload your resume/CV by clicking the Get Started button.

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
at all times maintains a professional demeanor to assure that patients are treated in an appropriate and compassionate manner