PN Account Specialist II

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

2d•Onsite

About The Position

The Account Specialist II, Insurance Follow-Up & Denials Management is responsible for insurance follow-up for Cook Children’s Physician Network (CCPN). The role follows up on, analyzes, and resolves outstanding insurance claims and initiates appeals on behalf of CCPN providers. It conducts reimbursement analysis and provides the Manager, Insurance Follow-Up & Denials Management with timely financial and volume data related to claims adjudication and payment trends. The specialist performs required patient account adjustments, provides feedback to practice managers about diagnostic and procedural coding effectiveness, and monitors active accounts receivable for potential problems. The position serves as a liaison between assigned practices and the billing office, communicates with patients, practice managers, physicians, and others regarding outstanding claims, and maintains appropriate documentation and work edits. The specialist is expected to maintain a professional demeanor and ensure patients are treated appropriately and compassionately. The position is based at the Calmont Operations Building in the CBO/PT Financial Services department. It is listed as first shift with standard weekly hours of 40. Cook Children’s is a Texas-only employer; employees must maintain their primary residence in Texas and maintain any required licenses and credentials throughout employment.

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.
Maintain primary residence in Texas throughout employment.
Maintain licenses and credentials required for the position throughout employment.

Nice To Haves

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

Responsibilities

Follow up on, analyze, and resolve outstanding insurance claims for Cook Children’s Physician Network.
Initiate the appeals process on behalf of CCPN providers.
Perform reimbursement analysis.
Provide the Manager, Insurance Follow-Up & Denials Management with timely financial and volume data about claims adjudication and payment trends.
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 help ensure patients are treated appropriately and compassionately.