Insurance Claims Follow-up

Location:

Department:

Shift:

Standard Weekly Hours:

Summary:

The Account Specialist II / Insurance Claims Follow-up is primarily responsible for all insurance follow-up responsibilities for the Cook Childrens Physician Network. Primary duties include follow-up analysis and resolution of outstanding insurance claims and initiation of the appeals process on behalf of CCPN providers. Will perform duties such as reimbursement analysis; providing updates to 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 the effectiveness of diagnostic and procedural coding; monitors active accounts receivable for identification of potential problems; serves as a 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.

Note: This is a remote position but will require 1-2 weeks of training in Fort Worth (candidates must live in Texas)

Required Education/Experience:

• High School or equivalent required.

• At least 3 years experience in a physician billing environment or at least two (2) years in the capacity of Account Specialist I with a satisfactory performance record.

• Intermediate knowledge of coding and medical terminology with an understanding of diversified health insurance plans a plus.

• Strong 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 is preferred.

• Prior experience with Epic Resolute Professional Billing preferred.

About Cook Childrens:

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 Childrens is honored to continually receive recognition for our outstanding efforts and outcomes in pediatric health care.

At Cook Childrens were more than a health care systemwere your friends neighbors and even family members. And were parents too so we can see the world through your eyes. We see what youre going throughand how we can help you and your child get the best care and support possible.

Cook Childrens is an equal opportunity employer. As such Cook Childrens offers equal employment opportunities without regard to race color religion sex age national origin physical or mental disability pregnancy protected veteran status genetic information or any other protected class in accordance with applicable federal laws. These opportunities include terms conditions and privileges of employment including but not limited to hiring job placement training compensation discipline advancement and termination.