PN Account Specialist II

Summary

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 claim adjudication and payment trend analyzes;
• 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.

Education & Experience

• 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. Medical terminology preferred.
• Prior experience with Epic Resolute Professional Billing preferred.

Cook Children's is an EOE/AA/Minority/Female/Disability/Veteran employer.