PN Reimbursement Specialist

Location:

Calmont Operations Building

Department:

CBO/PT Financial Services

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

The underpayment specialist is responsible for payment variance activities related to the incorrect processing of claims. Responsibilities include: validating underpayment variances and taking appropriate resolution steps, tracking underpayment recoveries, trending underpayments by payer and issue and successfully recovering underpaid amounts as efficiently as possible. Working under the direction of the Reimbursement Manager, the Underpayment Specialist to assist in troubleshooting system proration problems, payer issues and contract-related discrepancies. Variances are referred to the Underpayment Specialist via an underpayment work queue that calculates payment variances against expected reimbursement.
Education:

• High School diploma or equivalent.
• Experience 2 years hospital or physician revenue cycle or contracting experience required or 2 years experience working for a health plan in a capacity that pays claims and/or reviews contract terms.
• Ability to apply appropriate supervisory, management, and leadership techniques in an operational setting.
• Excellent ability to understand contract terms and calculate reimbursement.
• Knowledge of the principles of Information Systems in order to effectively collect on underpayment variances.
• Excellent written and oral communication skills to effectively communicate with payors and other departments
• Knowledge of healthcare related financial and/or accounting practices
• Ability to manipulate data using excel.
• Ability to deal effectively with constant changes and be a change agent.
• Healthcare/Business
• Detailed knowledge of health plan operations, reimbursement methodologies, payer contracts and clinical policies
• Knowledge of state, federal and compliance regulations as they pertain to coding and billing processes and procedures.
• Epic or prior experience with Epic Systems Revenue Cycle Solutions preferred

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 EOE/AA, Minority/Female/Disability/Veteran employer.