As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
The Accounts Receivable Senior Representative is responsible for all aspects of follow-up activity, to include taking appropriate steps to resolve accounts timely. This candidate should have an increased knowledge of the Revenue Cycle as it relates to the entire life of a patient account from creation to expected payment. Representative will need to effectively follow-up on claim submission and; remittance review for insurance collections, create and pursue disputed balances from both government and non-government entities. Basic knowledge of Commercial, Managed Care, Medicare and Medicaid insurance is preferable. . Participate and assist in special projects as well as provide A/R support to the team. Assist new or existing staff with training or techniques to increase production and quality as well as provide A/R support for the team members that may be absent or backlogged. An effective revenue cycle process is achieved with working as part of a dynamic team and the ability to adapt and grow in an environment where work assignments may change frequently while resolving more complex accounts with minimal or no assistance.
Senior Representative must have the abilty to work closely with management and team members working an inventory of collectible accounts that bring in revenue and possess the the following:
Conduct telephone calls utilizing a professional demeanor when contacting payors and/or patients in order to obtain collection related information
Basic computer skills to navigate through the various system applications provided for additional resources in determining account actions (may work in multiple systems for clients)
Access payer websites and discern pertinent data to resolve accounts
Utilize all available job aids provided for appropriateness in follow-up processes
Document clear and concise notes in the patient accounting system regarding claim status and any actions taken on an account
Maintain department daily productivity goals in completing a set number of accounts while also meeting quality standards as determined by leadership
Skilled in working with complex medical claim issues
Identify and communicate any issues including system access, payor behavior, account/work-flow inconsistencies or any other insurance collection opportunities
Compile data to substantiate and utilize to resolve payer, system or escalated account issues
Assist new or existing staff with training or techniques to increase production and quality
Provide support for team members that may be absent or backlogged
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Other duties may be assigned.
Researches each account using company patient accounting applications and internet resources that are made available. Conducts appropriate account activity on uncollected account balances with contacting third party payors and/or patients via phone, e-mail, or online. Problem solves issues and creates resolution that will bring in revenue eliminating re-work. Updates plan IDs, adjusts patient or payor demographic/insurance information, notates account in detail, identifies payor issues and trends and and solves re-coup issues. Requests additional information from patients, medical records, and other needed documentation upon request from payors. Reviews contracts and identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed. Takes appropriate action to bring about account resolution timely or opens a dispute record to have the account further researched and substantiated for continued collection. Maintains desk inventory to remain current without backlog while achieving productivity and quality standards.
Perform special projects and other duties as needed. Assists with special projects as assigned, documents findings, and communicates results to leaders.
Recognizes potential delays and trends with payors such as corrective actions and responds to avoid A/R aging. Escalates payment delays/ problem aged account timely to Supervisor.
Compile data to substantiate and utilize to resolve payer, system or escalated account issues.
Assist new or existing staff with training or techniques to increase production and quality as needed.
Participate and attend meetings, training seminars and in-services to develop job knowledge.
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Thorough understanding of the revenue cycle process, from patient access (authorization, admissions) through Patient Financial Services (billing, insurance appeals, collections) procedures and policies
Good written and verbal communication skills
Intermediate technical skills including PC and MS Outlook
Strong interpersonal skills
Above average analytical and critical thinking skills
Ability to make sound decisions
Has a full understanding of the Commercial, Managed Care, Medicare and Medicaid collections, Intermediate knowledge of Managed Care contracts, Contract Language and Federal and State requirements for government payors
Advanced knowledge of UB-04 and Explanation of Benefits (EOB) interpretation
Intermediate knowledge of CPT and ICD-9 codes
Advanced knowledge of insurance billing, collections and insurance terminology
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience required to perform the job.
High school diploma or equivalent education
2-5 years experience in Medical/Hospital Insurance related collections
Minimum typing requirement of 45 wpm
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Office/Team Work Environment
Ability to sit and work at a computer for extended periods of time
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Primary Location: Frisco, Texas
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Internal Number: 2105016441
About Conifer Health Solutions
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.