Revenue Cycle Manager
Providence
Patient Accounting Spec Sr
INTEGRIS Health
full-time
Posted on:
Origin: • 🇺🇸 United States • Oklahoma
Visit company websiteJob Level
Senior
About the role
- The Patient Accounting Specialist III is responsible for processing complex transactions such as complex services such as global transplant cases, payer audits, payer withholds and managing complex data from multiple sources; reviewing and resolving denied and underpaid/overpaid claims and carrying out the appeals process.
- Works to maintain third-party payer relationships, including responding to inquiries, complaints, and other correspondence related to denials, appeals/ payments and audits.
- 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.
- Maintains and monitors integrity of the claim development and submission process.
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
- Bachelors 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)
