Patient Accounting Specialist Sr

Responsibilities

• Process complex transactions such as global transplant cases, payer audits, payer withholds, and manage data from multiple sources.
• Review and resolve denied and underpaid/overpaid claims and carry out the appeals process.
• Maintain third-party payer relationships, respond to inquiries, complaints, and other correspondence related to denials, appeals/payments, and audits.
• Have a superior understanding of claims management, including provider-level benefits, third-party payer guidelines and contracts, state/federal laws, and all other functions of the job.
• 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, denial appeals process, including receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party and government payers in a timely manner.
• Monitor payer files for accuracy, ensure payer documentation is completed, and assist in updating files with pertinent information as necessary.
• Conduct relevant research to assist with resolving files or claims and to stay informed on best practices and policy reforms.
• Communicate accurately, clearly, concisely, and professionally with internal and external departments and organizations to resolve complex accounts.
• Prepare, maintain, assist with, and submit reports as required.
• Makes complex decisions within the scope of the position and works independently.
• Collaborates with team members to continually improve services and engage in process and quality improvement activities.
• Provides feedback to management on revenue opportunities and payer standards.
• Maintains thorough knowledge of state and federal regulations, accreditation/compliance requirements, and INTEGRIS Health policies, including those regarding fraud and abuse, confidentiality, and HIPAA.
• 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.

Qualifications

• 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.
• Bachelor’s 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.
• Must be able to communicate effectively in English (verbal/written).