Senior Patient Accounting Specialist

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 assists 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 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 and Fair Debt Collection Practices Must be able to communicate effectively in English (verbal/written) Core Competencies Demonstrates expertise in healthcare billing, collections, and denials management, with a strong understanding of relevant regulations and compliance requirements. Proficient in processing payment files and conducting appeals while collaborating effectively with internal and external stakeholders. Highest-signal resume keywords Healthcare Billing Experience Denials Management ICD-10 Coding CPT-4 Coding CRCR Certification ATS Optimization Keywords Hard Skills Payment Processing Claims Processing Auditing Data Analysis Report Preparation Legal Document Knowledge Contract Document Knowledge Billing Software Proficiency Microsoft Office Proficiency Third-Party Contract Management Soft Skills Effective Communication Problem Solving Collaboration Attention to Detail Professional Correspondence Certifications & Qualifications CRCR CRCS CHAA Industry Keywords Healthcare Regulations Medicare Denials Medicaid Denials NCQA Guidelines Fair Debt Collection Practices #J-18808-Ljbffr Jobtailor