专业计费专员（麻醉）
Professional Billing Specialist (Anesthesia)
公司简介
Shriners Children’s 是一个尊重、支持并重视每个人的组织。被福布斯评为2025年最佳中型企业雇主，我们致力于提供卓越的患者护理，拥抱具有全球影响力的多学科教育和研究。我们营造一个重视循证实践、经验、创新和批判性思维的学习环境。我们的同理心、诚信、责任感和韧性定义了我们在儿童专科护理领域的领导地位，为我们的儿童及其家庭服务。
我们在全球拥有20多家医院、门诊诊所、日间护理中心和外展地点，无论家庭支付能力或保险状况如何，我们都为18岁以下的儿童提供优质的护理。请点击此处了解我们的更多地点信息。
职位描述
专业账单专员（麻醉）负责管理所有专业账单要求以及根据标准和生产率衡量指标管理应收账款任务。负责确保遵循所有监管和付款方指南。
主要职责：
- 协调付款方拒绝和上诉跟进活动，以确保第三方付款方及时响应，并处理所有付款方拒绝、文件请求和上诉
- 审查所有拒绝账户以进行分类、上诉级别及启动上诉的特殊要求
- 与付款方关系团队沟通全球付款方问题
- 与各种个人/部门沟通协调，并协助监控与上诉跟进和拒绝相关的日常活动
- 维护医疗跟踪工具/应用程序，存储/传达所有索赔编辑、审查和拒绝活动。这包括用户访问管理、软件更新和最终用户培训，以支持所有后续活动
- 监控所有索赔编辑和拒绝管理的工作队列和列表，确保全部解决
- 确保医疗记录请求在48小时内完成并提交
- 在数据库中跟踪所有拒绝以确定结果。收集/分析，报告由工具产生的不同审查的状态、指标和趋势。定期向特定分发组分发报告
- 以可检索的方式组织所有数据和活动，以确保对第三方付款方的上诉进行及时跟进。协助协调拒绝事宜
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Company Overview
Shriners Children’s is an organization that respects, supports, and values each other. Named as the 2025 best mid-sized employer by Forbes, we are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience define us as leaders in pediatric specialty care for our children and their families.
With 20+ hospitals, outpatient clinics, ambulatory care centers and outreach locations across the globe, we provide excellent care to children up to age 18 regardless of their family’s ability to pay or insurance status. Please click here to learn more about our locations.
Job Description
The Professional Billing Specialist (Anesthesia) is responsible for managing all professional billing requirements and managing accounts receivable tasks according to standard and productivity measurements. Responsible to ensure all regulatory and payor guidelines are followed.
Key Responsibilities:
- Coordinating payor denial and appeal follow up activities to ensure timely response from third party payors and the processing of all payor denials, documentation requests and appeals
- Review all denial accounts for categorization, level of appeal, special requirements for initiating appeals
- Communicate global payer issues with the payer relations team.
- Communicating and coordinating with various individuals/distributions and assisting with monitoring of the day-to-day activities related to appeal follow up and denials.
- Maintaining the healthcare tracking tool/application that stores/communicates all claim edits, review and denial activity. This will include user access management, updates to software, and end-user training to support all follow up activities.
- Monitor all Claim Edit and Denial Management work queues and lists to ensure they are fully resolved.
- Ensure medical records requests are completed and submitted within 48 hours.
- Track all denials on a database to determine outcome. Collecting/analyzing, report status, metrics and trends of activity by different reviews from the tool. Distributing reports on a routine basis to specific distribution group.
- Organizing all data and activity in a retrievable way to ensure timely follow up on appeals to third party payors. Assisting with the coordination of denial and review activities and materials for committee meetings, including analyses, reports, etc.
- Knowledgeable about federal, state and third-party claims processing. Supporting projects and initiatives of the Billing and Denials Management teams. This may include coordinating meetings, conducting research for payor criteria, and preparing documents
- Able to build and maintain relationships with payer representatives
Required Qualifications:
- Epic PB Resolute experience
- 3 years of related Anesthesia experience
- 5 years' experience in a Healthcare/Hospital Revenue Cycle Environment including Third Party Collection/AR Receivables
- Healthcare Revenue Cycle revenue management EDI Transaction sets including 837P
- Knowledge of insurance contract rates and terms
- Understanding of Registration and Collections
- Understanding of Government and Managed Care billing, coverage and payment rules Ability to comprehend payor 835 and paper EOB responses
- Understanding of CCI edits, CPT, HCPCS, ICD-10 and Revenue Codes
- Intermediate Excel skills
- Excellent computer skills, especially spreadsheet and database applications.
- Knowledge of managed care patient financial systems and of the specific billing and payment standards utilized for services provided within a hospital setting.
- Thorough understanding of managed care payment methodologies and the principles of managed care.
- Certification in Epic PB Resolute - or agree to obtain certification within 12 months after hire
- Bachelor’s Degree or equivalent combination of education and experience
Preferred Qualifications:
- Knowledge of SQL or Crystal Reports.
- HFMA’s CRCR credential
The pay range for this position is $24.16 - $36.24. Compensation is determined based on years of relevant experience and departmental equity.Originally posted on Himalayas