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Senior Patient Accounting Specialist – Physician Billing
INTEGRIS HealthSenior patient accounting specialist managing physician billing and complex claims for Oklahoma's largest not-for-profit health system. Resolving denials, appeals, payer audits, and reimbursement issues in a hybrid Oklahoma City role.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
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 ExperienceClaims Management SoftwareDenials ManagementKnowledge of ICD-10 and CPT-4Effective Communication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Healthcare BillingClaims ProcessingDenials ManagementPayment ProcessingDRG KnowledgeICD-10 KnowledgeCPT-4 KnowledgeUB04/CMS-1500 BillingAuditing SkillsData Analysis
Soft Skills
Problem-SolvingCollaborationProfessional CommunicationAttention to DetailDecision-Making
Tools & Technologies
Microsoft OfficeBilling SoftwareClaims Management Software
Certifications & Qualifications
CRCRCRCSCHAA
Industry Keywords
Payer AuditsThird-Party Payer RelationshipsMedicare DenialsMedicaid DenialsNCQA GuidelinesFair Debt Collection PracticesState and Federal RegulationsAccreditation RequirementsHIPAA ComplianceFraud and Abuse
About the role
Key responsibilities & impact- 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
What you’ll need- 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
Benefits
Comp & perks- Front-loaded PTO
- Medical benefits through the extensive INTEGRIS Health network
- Financial assistance for continued education
- 24/7 mental health support
- Career and development opportunities