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Insurance Claims Specialist II

2 months ago

Fort Worth, Texas, United States Cook Children's Health Care System Full time
Job Summary

Cook Children's Health Care System is seeking a highly skilled Insurance Claims Specialist II to join our team. This role is responsible for managing all insurance follow-up responsibilities for Cook Children's Physician Network.

Key Responsibilities
  • Follow-up, analysis, and resolution of outstanding insurance claims
  • Initiation of the appeals process on behalf of CCPN providers
  • Reimbursement analysis and provision of timely financial and volume data related to claims adjudication and payment trend analyses
  • Performance of all required patient account adjustments
  • Feedback to practice managers regarding effectiveness of diagnostic and procedural coding
  • Monitoring of active accounts receivable for identification of potential problems
  • Liaison between assigned practice(s) and billing office
  • Effective communication with patients, practice managers, physicians, and others regarding collection of outstanding claims
  • Maintenance of proper documentation and edits of work performed
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, 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