Sistemul de servicii medicale INTEGRIS Health, deținut de statul Oklahoma, deservește comunitățile din întregul stat prin spitale, centre de recuperare, clinici medicale, unități de sănătate mintală, centre de îngrijire urgentă, agenții de îngrijire medicală la domiciliu, centre de fitness și comunități de locuințe independente. Activitatea sa reunește o rețea extinsă de profesioniști din domeniul sănătății, preocupați să ajute familiile din Oklahoma să ducă o viață mai sănătoasă prin îngrijire empatică și de calitate. Organizația oferă, de asemenea, oportunități de carieră într-o gamă largă de specializări medicale și funcții de sprijin.
Senior Physician Billing Specialist
Resolve complex physician billing claims, denials, and appeals at INTEGRIS Health. Manage payer relationships, reimbursement data, compliance, and process improvements.
Descriere
- Handle complex transactions, payment files, claims, insurance collections, and physician charge entry
- Review and resolve denied, underpaid, and overpaid claims, including appeals
- Manage relationships with third-party payers and respond to inquiries, complaints, correspondence, denials, appeals, payment matters, and audits
- Audit, document, track, and resolve appeals with third-party and government payers
- Check payer files for accuracy and update related documentation
- Research claims, files, best practices, and policy changes
- Coordinate with internal departments and external organizations to resolve complex accounts
- Track payer issues, underpayments, banking errors, and payment trends, and recommend improvements
- Prepare and maintain reports, contribute to their development, and submit them
- Make complex decisions independently within the role’s scope
- Contribute to service, process, and quality improvement work
- Advise management on revenue opportunities and payer standards
- Stay current on regulations, compliance requirements, and INTEGRIS Health policies
- Identify improvement opportunities and help test system changes with IT and department managers
- Take part in professional development
- Report to the department manager or supervisor
Cerințe
- At least four years of experience in healthcare billing, collections, payment processing, or denials management
- Experience in at least three healthcare areas, such as billing and collections, denials, or registration
- Healthcare certification such as CRCR, CRCS, or CHAA preferred
- Bachelor’s degree preferred
- Experience with DRG, ICD-10, CPT-4, and UB-04/CMS-1500 claim billing
- Knowledge of legal and contract documents, collection agency procedures, and legal procedures
- Experience using Microsoft Office and billing and claims management software
- Experience with hospital and physician billing and reimbursement; Medicare, Medicaid, and commercial payer denials and appeals; third-party contracts; NCQA guidelines; federal and state regulations; and Fair Debt Collection Practices
- Effective verbal and written communication in English
- Ability to follow standard precautions
- Ability to comply with fraud and abuse, confidentiality, HIPAA, accreditation, and other compliance requirements
Beneficii
- Front-loaded paid time off
- Medical benefits through the INTEGRIS Health network
- Financial assistance for continuing education
- 24/7 mental health support
- Career growth and development opportunities