Patient Accounting Specialist Sr

About Us

INTEGRIS Health is Oklahoma's largest not-for-profit health system, dedicated to partnering with people to live healthier lives. Our mission is to provide unprecedented access to quality and compassionate health care. INTEGRIS Health operates hospitals, rehabilitation centers, physician clinics, mental health facilities, and home health agencies throughout much of Oklahoma, offering some of the state's best career and development opportunities.

Responsibilities

• Process complex transactions such as global transplant cases, payer audits, payer withholds, and manage complex data from multiple sources.
• Review and resolve denied, underpaid, or overpaid claims and carry out the appeals process.
• Maintain third-party payer relationships, including responding to inquiries, complaints, and other correspondence related to denials, appeals, payments, and audits.
• Demonstrate superior understanding of claims management, including provider-level benefits, third-party payer guidelines and contracts, state/federal laws, and all other job functions.
• Maintain and monitor the integrity of the claim development and submission process.
• Import and process payment files, claim processing, collection of insurance, and/or physician charge entry.
• Execute the auditing and denial appeals process, including receiving, assessing, documenting, tracking, responding to, and resolving appeals with third-party and government payers in a timely manner.
• Monitor payer files for accuracy, ensure payer documentation is completed, and update files with pertinent information as necessary.
• Conduct relevant research to assist with resolving files or claims and stay informed on best practices and policy reforms.
• Conduct internal and external correspondence accurately, clearly, concisely, and professionally while following organizational regulations.
• Work with internal departments and external organizations to resolve complex accounts.
• Maintain data for trending purposes on payer issues, underpayments, banking errors, and payment trends; collaborate with team members to make recommendations for improvements and resolving issues.
• Prepare, maintain, assist with, and submit reports as required.
• Make complex decisions within the scope of the position and work independently.
• Collaborate with team members to continually improve services and engage in process and quality improvement activities; provide feedback to management on revenue opportunities and payer standards.
• Maintain thorough knowledge of and effectively communicate state and federal regulations, accreditation/compliance requirements, and INTEGRIS Health policies, including those regarding fraud and abuse, confidentiality, and HIPAA.
• Identify improvement opportunities and contribute to the testing of system modifications; work closely with IT staff and department managers to ensure proper implementation.
• Participate in professional development to enhance job knowledge and performance.
• Conduct research to assist with completing the appeals process and stay informed on best practices and policy reforms.
• Note: This position may have additional or varied physical demand and/or respiratory fit test requirements. Potential for exposure to infections, communicable diseases, blood and body fluids, electrical equipment, and chemicals; must follow standard precautions.

Qualifications

• Four years of experience in healthcare billing, collections, payment processing, or denials management (denials management experience preferred).
• Understanding of or experience in 3+ areas of healthcare such as billing and collections, denials, registration, or a combination of these (preferred).
• Healthcare certification (CRCR, CRCS, CHAA) preferred.
• Bachelor’s Degree preferred.
• Previous experience with DRG, ICD-10, CPT-4, and UB04/CMS-1500 claim billing.
• Knowledge of legal documents, contract documents, collection agency procedures, and legal procedures.
• Previous experience with Microsoft Office and billing/claims management software.
• 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 appeals, and Fair Debt Collection Practices.
• Ability to communicate effectively in English (verbal and written).

Benefits

• Front-loaded PTO (Paid Time Off).
• Medical benefits through the extensive INTEGRIS Health network.
• Financial assistance for continued education.
• 24/7 mental health support.