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Senior Patient Accounting Specialist – Physician Billing
INTEGRIS Health. Process complex transactions, including global transplant cases, payer audits, payer withholds, and complex data from multiple sources .
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 compliance regulations and payer relationships. Proficient in processing complex transactions and executing appeals while maintaining accurate documentation and reporting.
Highest-signal resume keywords
Healthcare Billing ExperienceDenials ManagementClaims ProcessingHealthcare Certification (CRCR, CRCS, CHAA)Knowledge of ICD-10 and CPT-4
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ManagementPayment ProcessingAuditingData AnalysisAppeals ProcessDocumentationRevenue Cycle ManagementPayer RelationsCompliance KnowledgeLegal Procedures
Soft Skills
Effective CommunicationProblem SolvingCollaborationAttention to DetailDecision Making
Tools & Technologies
Microsoft OfficeBilling SoftwareClaims Management Software
Certifications & Qualifications
CRCRCRCSCHAA
Industry Keywords
MedicareMedicaidThird-Party ContractsNCQA GuidelinesFair Debt Collection PracticesFederal RegulationsState Regulations
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 and underpaid/overpaid claims and carry out the appeals process
- Maintain third-party payer relationships and respond to inquiries, complaints, and correspondence related to denials, appeals, payments, and audits
- Import and process payment files, process claims, collect insurance, and/or enter physician charges
- Execute auditing and denial appeals, including receiving, assessing, documenting, tracking, responding to, and resolving appeals
- Monitor payer files for accuracy and update documentation
- Research claims, files, best practices, and policy reforms
- Conduct accurate internal and external correspondence
- Work with internal departments and external organizations to resolve complex accounts
- Maintain data for trending payer issues, underpayments, banking errors, and payment trends
- Prepare, maintain, assist with, and submit reports
- Make complex decisions independently within the scope of the position
- Collaborate on service improvements, process improvement, and quality improvement activities
- Provide feedback to management on revenue opportunities and payer standards
- Maintain knowledge of state and federal regulations, compliance requirements, and INTEGRIS Health policies, including fraud and abuse, confidentiality, and HIPAA
- Contribute to system modification testing and work with IT staff and department managers on implementation
- Participate in professional development
- Report to the manager or supervisor of the department as assigned
Requirements
What you’ll need- 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)
- Must follow standard precautions
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