PN Account Specialist II

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

92d

About The Position

The Account Specialist II, Insurance Follow-Up & Denials Management is responsible for all insurance follow-up responsibilities for Cook Children's 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.
• 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.
• 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.
• Perform reimbursement analysis.
• Provide timely financial and volume data related to claims adjudication and payment trend analyses.
• Perform all required patient account adjustments.
• Provide feedback to practice managers regarding effectiveness of diagnostic and procedural coding.
• Monitor active accounts receivable for identification of potential problems.
• Serve as liaison between assigned practice(s) and billing office.
• Communicate effectively with patients, practice managers, physicians and others regarding collection of outstanding claims.
• Maintain proper documentation and edits of work performed.
• Maintain a professional demeanor to assure that patients are treated in an appropriate and compassionate manner.

What This Job Offers

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