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Accounts Resolution Specialist II

2 months ago

Wayne, United States Pennsylvania Medicine Full time

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Entity: CPUP

Location: 145 King of Prussia Road

Department: Oral Surgery

Hours: Full Time, per departmental needs

Summary:

The Accounts Resolution Specialist II reports to the Supervisor of Billing; this individual specializes in the resolution of patient accounts transferred from the PBO. This position will investigate and follow up on claim edits and work denials and underpayments by insurance carriers regarding open balance to obtain payment. Act as a subject matter expert escalated issues and provide insight on identified denial trends or root cause of denials to mitigate future denials, expedite the reprocessing of claims and maximize opportunities to enhance front end claim edits to facilitate a first pass resolution. They may assist with training and mentoring other staff members according to the organization's training program.

Responsibilities:

  • Serves as first point of contact for addressing more complex account issues, patient concerns, and billing and insurance questions
  • Utilize and work the self-pay report, denials report, and AR report
  • Responsible for patient account research in relation to working accounts within the claim edit work queue and follow-up work queue
  • Identify untimely accounts and performs accurate and timely write offs adhering to policy guidelines
  • Responsible for maintaining the highest level of billing standards following current guidelines from Medicare, Medicaid, and other insurance entities.
  • Meets or exceeds established performance targets (productivity and quality) established by the Supervisor of Billing
Education or Equivalent Experience:
  • H.S. Diploma/GED (Required)
  • 5+ years work experience in Patient Access, Revenue Cycle, or Patient Accounting/Billing (Required)
  • Associate of Arts or Science (Preferred)
Skills & Abilities:

  • Healthcare (professional) billing, knowledge of CPT/ICD-10 coding, government, managed care and commercial insurances, claim submission requirements, reimbursement guidelines, and denial reason codes (Required)
  • Knowledge of other front-end processes, including scheduling, pre-registration, financial counseling, and registration (Required)
  • Efficient time management skills and ability to multitask (Preferred)
  • Strong computer literacy skills including proficiency in Microsoft Office (Preferred)
  • Excellent organization skills, attention to detail, research and problem solving ability (Preferred)
  • Results oriented with a proven track record of accomplishing tasks within a high-performing team environment (Preferred)

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.