Responsible for managing patient account staff in processing accounts and working with designated payers to ensure proper reimbursement. Ownership of assigned Payer AR and all activities required to identify underpayments and prepare accounts for escalation to the payers in order to drive account resolution. Resolve claims in a timely manner by completing appeals as needed or driving materials and accounts through the Plan Manager to the Payer.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Other duties may be assigned.
Manages the aging of accounts receivable by trending and analyzing the A/R, and through communication with the payers/managers. Monitors collection processes to determine cash flow improvement opportunities.
In depth knowledge of applicable contracts. Continual QA and analysis of underpayment risk areas to ensure audit accuracy. Ensure compliance with state and federal laws and regulations. Maintains a thorough understanding of health insurance and government programs, where necessary.
Prepare escalation packages, pre demand packages and any necessary Payer materials with corroborating contract support for submission to the Manager and ultimately the Payer.
Monitor payer memos and create communication on changes to support teams
Respond to claim denials from insurance companies to ensure contractual payment of submitted claims and Resubmit claims and write appeals to insurance companies.
Collaboration with various support teams on identified issues (includes issue logs).
If direct report positions are listed below, the following responsibilities will be performed in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
No. Direct Reports (incl, titles): Patient Acct Reps, Sr Patient Acct Reps, Lead Patient Acct Reps, and Patient Acct Supervisors
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.
Advanced knowledge of healthcare A/R
Excellent working knowledge of Patient Financial Services operations with specific focus on Inpatient and Outpatient Managed Care and Commercial payors (i.e., Medicare regulations and compliance; HIPAA)
Proficient in Microsoft Office (Word and Excel)
Advanced writing skills
Ability to provide advanced customer service
Ability to plan and implement process improvements
Ability to train and coach staff
Ability to multi-task
Strong leadership and organizational skills
Proficient in building a strong team to meet performance goals
Very good written and verbal communication skills
Strong interpersonal skills
Strong technical skills, including PC and MS Office Suite knowledge
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
Bachelorâ��s degree preferred in Healthcare Administration, Business or related area or equivalent experience. MBA/CPA preferred
2-4 years experience in Healthcare Administration or Business Office
CERTIFICATES, LICENSES, REGISTRATIONS
HFMA-Patient Accounts or Hospital Accounting Certification encouraged
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.
Ability to sit and work at a computer terminal 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.
Call Center environment with multiple workstations in close proximity
Provide any additional information or requirements that would be helpful to someone trying to understand the nature, scope or purpose of this position., not to exceed
Job: Conifer Health Solutions
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: 2105021426
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.