Senior Patient Accounting Specialist - Physician Billing

Role Overview

• Responsible for importing and processing of payment files, claim processing, collection of insurance, and/or physician charge entry
• Executes the auditing, denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party and government payers in a timely manner.
• Monitors payer files for accuracy, ensures payer documentation is completed and assist in updating files with pertinent information as necessary.
• Conducts relevant research to assist with resolving files or claims and to stay informed on best practices and policy reforms.
• Conducts internal and external correspondence accurately, clearly, concisely, and professionally while following organizational regulations.
• Works with internal departments and external organizations to resolve complex accounts.
• Maintains data for trending purposes on payer issues, underpayments, banking errors, payment trends and collaborates with team members to make recommendations for improvements and resolving issues.
• Prepares, maintains, assist with, and submits reports as required.
• Regularly makes complex decisions within the scope of the position, and is comfortable working independently.
• Collaborates with team members to continually improve services, and engages in process and quality improvement activities. Provides feedback to management on revenue opportunities and payer standards.
• Maintains thorough knowledge and can communicate effectively state and federal regulations, accreditation/compliance requirements, and INTEGRIS Health policies, including those regarding fraud and abuse, confidentiality, and HIPAA.
• Pinpoints improvement opportunities and contributes to the testing of system modifications; works closely with IT staff and department managers to ensure proper implementation.
• Participates in professional development to enhance job knowledge and performance.
• Conducts relevant research to assist with completing the appeals process and to stay informed on best practices and policy reforms.

Requirements

• Four years experience in healthcare billing, collections, payment processing, or denials management (denials management experience preferred)
• Understands or has worked in 3+ areas of healthcare such as billing and collections and denials or registration and billing and collections preferred
• Healthcare certification (CRCR, CRCS, CHAA) preferred
• Bachelors Degree preferred
• Previous experience in DRG, ICD-10, CPT-4 and UB04/CMS-1500 claim billing
• Knowledge of legal documents, contract documents, and collection agency procedures and legal procedures
• Previous experience in Microsoft Office and experience with billing and claims management software
• Previous experience with hospital billing and reimbursement, physician billing and reimbursement, Medicare and Medicaid denials and appeals, commercial payer denials and appeals, third-party contracts, NCQA guidelines for denials and appeals, Federal and State regulations relating to denials and appeal and Fair Debt Collection Practices
• Must be able to communicate effectively in English (verbal/written)

Benefits

• front loaded PTO
• 100% INTEGRIS Health paid short term disability
• increased retirement match
• paid family leave