Overview
A healthcare organization specializing in pediatric specialty care is seeking a Professional Billing Specialist (Anesthesia) to manage professional billing requirements and accounts receivable tasks. This role ensures compliance with regulatory and payor guidelines while supporting revenue cycle operations.
Responsibilities
- Coordinate payor denial and appeal follow-up activities to ensure timely responses and processing
- Review denial accounts for categorization, appeal levels, and special requirements
- Communicate payer issues with the payer relations team
- Collaborate with various stakeholders to monitor day-to-day appeal follow-up and denial activities
- Maintain healthcare tracking tools/applications for claim edits, review, and denial activity, including user access management, software updates, and end-user training
- Monitor claim edit and denial management work queues to ensure resolution
- Ensure medical records requests are completed and submitted within 48 hours
- Track denials in a database to analyze outcomes, report status, metrics, and trends; distribute reports regularly
- Organize data and activities to ensure timely follow-up on appeals
- Assist with coordination of denial and review activities for committee meetings, including analyses and reports
- Maintain knowledge of federal, state, and third-party claims processing
- Support billing and denials management projects and initiatives, including meeting coordination and research
- Build and maintain relationships with payer representatives
Additional duties and special projects may be assigned.
Requirements
- Experience with Epic PB Resolute
- Minimum 3 years of anesthesia-related experience
- At least 5 years in a healthcare/hospital revenue cycle environment, including third-party collections and accounts receivable
- Knowledge of healthcare revenue cycle revenue management and EDI transaction sets, including 837P
- Understanding of insurance contract rates and terms
- Familiarity with registration and collections processes
- Knowledge of government and managed care billing, coverage, and payment rules
- Ability to interpret payor 835 and paper Explanation of Benefits (EOB) responses
- Understanding of CCI edits, CPT, HCPCS, ICD-10, and revenue codes
- Intermediate Excel skills and strong computer proficiency, especially with spreadsheets and databases
- Knowledge of managed care patient financial systems and hospital billing/payment standards
- Thorough understanding of managed care payment methodologies and principles
- Certification in Epic PB Resolute or willingness to obtain certification within 12 months of hire
- Bachelor’s degree or equivalent combination of education and experience
Preferred Qualifications
- Knowledge of SQL or Crystal Reports
- HFMA’s CRCR credential
Compensation & Benefits
- Medical coverage eligibility from the first day of employment
- Eligibility for 403(b) and Roth 403(b) retirement savings plans with matching contributions up to 6% after one year
- Paid time off, life insurance, short-term and long-term disability, Flexible Spending Account (FSA), and Health Savings Account (HSA) options for full-time and part-time employees (40+ hours per pay period)
- Additional benefits including tuition reimbursement, home and auto insurance, hospitalization, critical illness, pet insurance, and more
- Benefits coverage available to employees and qualified dependents, subject to state law
Location
Position location details were not specified.