Senior Patient Accounting Specialist - Physician Billing

Process complex transactions including global transplant cases, payer audits, payer withholds, and complex data from multiple sources Review and resolve denied, underpaid, and overpaid claims and carry out the appeals process Maintain third-party payer relationships by responding to inquiries, complaints, and correspondence regarding denials, appeals, payments, and audits Import and process payment files, process claims, collect insurance, and/or perform physician charge entry Execute auditing and denial appeals, including receiving, assessing, documenting, tracking, responding to, and resolving appeals with third-party and government payers Monitor payer files for accuracy and update pertinent information Research files, claims, best practices, and policy reforms Conduct accurate and professional internal and external correspondence Work with internal departments and external organizations to resolve complex accounts Maintain trending data on payer issues, underpayments, banking errors, and payment trends; recommend improvements Prepare, maintain, assist with, and submit reports Make complex decisions independently within the position's scope Collaborate on service, process, and quality improvement activities and provide management feedback Maintain knowledge of state and federal regulations, accreditation and compliance requirements, INTEGRIS Health policies, fraud and abuse, confidentiality, and HIPAA Identify improvement opportunities and contribute to testing system modifications with IT staff and department managers Participate in professional development Report to the department manager or supervisor as assigned Requirements Four years of experience in healthcare billing, collections, payment processing, or denials management Understanding of or experience in at least three areas of healthcare, such as billing and collections, denials, registration, and billing and collections 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 Experience with Microsoft Office and billing and 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, federal and state regulations, and Fair Debt Collection Practices Must be able to communicate effectively in English, verbally and in writing Healthcare certifications such as CRCR, CRCS, or CHAA preferred Bachelor's degree preferred Must follow standard precautions due to potential exposure to infections, communicable diseases, blood and body fluids, electrical equipment, and chemicals Core Competencies Demonstrates expertise in healthcare billing, collections, and denials management, with a strong understanding of relevant regulations and compliance requirements. Proficient in processing complex transactions and managing payer relationships while effectively communicating with internal and external stakeholders. Highest-signal resume keywords Healthcare Billing Experience Claims Management Software Denials Management Knowledge of ICD-10 and CPT-4 Effective Communication Skills ATS Optimization Keywords Hard Skills Healthcare Billing Claims Processing Denials Management Payment Processing DRG Knowledge ICD-10 Knowledge CPT-4 Knowledge UB04/CMS-1500 Billing Auditing Skills Data Analysis Soft Skills Problem-Solving Collaboration Professional Communication Attention to Detail Decision-Making Certifications & Qualifications CRCR CRCS CHAA Industry Keywords Payer Audits Third-Party Payer Relationships Medicare Denials Medicaid Denials NCQA Guidelines Fair Debt Collection Practices State and Federal Regulations Accreditation Requirements HIPAA Compliance Fraud and Abuse Tools & Technologies Microsoft Office Billing Software Claims Management Software #J-18808-Ljbffr Jobtailor