Summary: The Account Specialist II, Insurance Follow-Up& Denials Management is responsible for all insurance follow-upresponsibilities for Cook Children's Physician Network. Primary duties are;follow-up, analysis, and resolution of outstanding insurance claims; initiationof the appeals process on behalf of CCPN providers. The Account Specialist II,Insurance Follow-Up & Denials Management will primarily be responsible forperforming duties such as; reimbursement analysis; provides the Manager,Insurance Follow-Up & Denials Management with timely financial and volumedata related to claims adjudication and payment trend analyses; performs allrequired patient account adjustments; provides feedback to practice managersregarding effectiveness of diagnostic and procedural coding; monitors activeaccounts receivable for identification of potential problems; serves as liaisonbetween assigned practice(s) and billing office; communicates effectively withpatients, practice managers, physicians and others regarding collection ofoutstanding claims; maintains proper documentation and edits of work performed;and at all times maintains a professional demeanor to assure that patients aretreated in an appropriate and compassionate manner.
High School or equivalent required.
Intermediate knowledge of coding and medical terminologywith understanding of diversified health insurance plans a plus.
At least 3 years' experience in a physician billingenvironment or at least two (2) years in the capacity of PN Account SpecialistI, 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 payormethodology.
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 Billingpreferred.