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.
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.