Claims Resolution Specialist

Location:

Department:

Shift:

Standard Weekly Hours:

Summary:

The Claims Resolutions Specialist/Account Specialist II is primarily responsible for all insurance follow-up responsibilities for the Cook Children's Physician Network. Primary duties include follow-up, analysis, and resolution of outstanding insurance claims, and initiation of the appeals process on behalf of CCPN providers. Will perform duties such as reimbursement analysis; providing updates to the Manager, Insurance Follow-Up & Denials Management with timely financial and volume data related to claims adjudication and payment trend analyses; performs all required patient account adjustments; provides feedback to practice managers regarding the effectiveness of diagnostic and procedural coding; monitors active accounts receivable for identification of potential problems; serves as a liaison between assigned practice(s) and billing office; communicates effectively with patients, practice managers, physicians and others regarding collection of outstanding claims; maintains proper documentation and edits of work performed; and at all times maintains a professional demeanor to assure that patients are treated in an appropriate and compassionate manner.

Note: This is a remote position but will require 1-2 weeks of training in Fort Worth as well as some on site work as needed (candidates must live in DFW area).

Required Education/Experience:

• High School or equivalent required.

• At least 3 years' experience in a physician billing environment (or) at least two (2) years working as an Account Specialist I with Cook Children's with a satisfactory performance record.

• Intermediate knowledge of coding and medical terminology.

• Strong understanding of diversified health insurance plans a plus.

• Experience with managed care contracts, denials and payor methodology.

• Extensive knowledge of healthcare third-party reimbursement, variance and denial records.

• Effective oral and written communication skills.

• Prior experience with Epic Resolute Professional Billing preferred.

About Cook Children’s:

Our not-for-profit organization is comprised of a flagship medical center in Fort Worth, Texas, a new medical center in Prosper, Texas, a physician network, home health company, surgery centers, health plan, health services, and health foundation. With more than 60 primary, specialty and urgent care locations throughout Texas, families can access our top-ranked specialty programs and network of services to meet the unique needs of their child. Cook Children's is honored to continually receive recognition for our outstanding efforts and outcomes in pediatric health care.

At Cook Children's, we're more than a health care system––we're your friends, neighbors and even family members. And we're parents too, so we can see the world through your eyes. We see what you're going through––and how we can help you and your child get the best care and support possible.
 

Cook Children’s is an equal opportunity employer. As such, Cook Children’s offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination.