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 primary purpose of the REP, PHYS SVC AR III team is to pursue reimbursement of services rendered and achieve accounts receivable resolution. This team works through open accounts receivables (denials and delinquent accounts) by actively calling payer organizations or utilizing web-based connectivity. Team members manage accounts by utilizing the IDX Paperless Collection System and Epic follow-up work queues.
The core responsibilities of a REP, PHYS SVC AR III is to perform collection follow-up steps with insurance carriers and/or patients regarding open accounts receivable and/or delinquent accounts to result in maximum cash collections for our clients. Specific tasks include resolving insurance carrier denials, appealing claims, contacting carriers on open accounts and responding to insurance carrier correspondence and/or inquiries. This position holds additional duties with respect to research, client contact and participation in employee training with possible exposure to multiple practice management systems.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Contact insurance carriers through website, email or telephone to resolve outstanding accounts
Analyze and resolve moderately complex insurance denials including coding review to prevent errors within appeals process
Appeal and/or resubmit unresolved invoices to insurance carriers
Research and respond to insurance correspondence
Update registration information, post denial codes and adjustments in practice management systems
Research and obtain required documents to resolve misdirected payment issues
Analyze weekly denial reports to spot trends; assess opportunities to improve internal workflows
Maintain internal logs (Excel format)
Assist in employee training and mentorship
Contact client for missing data elements or confirmation of information
Others may be assigned.
Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.
EDUCATION / EXPERIENCE
High school diploma or equivalent
2-4 years experience in healthcare collections and/or healthcare related field
Previous experience with IDX or Epic medical billing systems preferred
Knowledge of CPT, ICD-9 and HCPCS codes
Sharp intelligence of government payers and other commercial/managed care carrier rules and processes in a professional billing environment
Attention to detail with the ability to identify/resolve problems and document the outcome
Strong written and verbal communication skills
Excellent analytical and problem solving skills
Ability to multi-task and recognize trends to effectively work A/R
Solid skill with Microsoft Office applications: Word, Excel
Initiative to learn new tasks and the ability to apply acquired knowledge to future duties
Flexibility, adaptability and accountability are necessary for optimum client results
Builds Team Relationships - Invites others to share opinions. Partners with employees in other departments. Actively seeks ways to help team members.
Communicates Effectively â�� Expresses ideas clearly and succinctly with small or large audiences. Listens attentively to speakerâ��s message without interruption. Tailors writing to audience using correct grammar and spelling.
Compliance with Laws, Policies and Procedures - Adheres to company handbook and policies. Demonstrates behavior consistent with Code of Conduct. Adheres to compliance program and guidelines.
Develops Self - Seeks opportunities for continuous learning. Modifies behavior in response to feedback. Knows personal strengths and weaknesses and demonstrates ownership for personal development.
Displays Adaptability â�� Performs well in high pressure or stressful situations. Works effectively when direction is unclear or rapidly changing. Demonstrates persistence in the face of obstacles.
Drives for Results - Delivers high quality work and attains results. Demonstrates personal drive and pushes self and others for results and quality work. Response appropriately to urgent situations.
Focus on the Customer/Client â�� Ensures that clients have a positive experience. Responds to clients in a timely manner. Demonstrates tact and empathy when responding to clients.
Respects Others - Displays sensitivity to the needs and concerns of others. Interacts with others in an open, non-threatening manner.
Shows Reliability â�� Takes personal responsibility for actions and decisions. Consistently works assigned schedule. Acts responsibly and can be counted on to accomplish goals successfully.
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.
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.