Tenet, through its subsidiaries, owns and operates acute care hospitals and numerous related health care services. Our mission is to be recognized for our commitment to our people and partners who provide quality, innovative care to the patients we serve in our communities. It's a spirit you can experience first-hand and it's a philosophy that can enhance your own approach to health care and your career goals.
At Conifer Health Solutions, we offer the strength and stability of Tenet Healthcare, a Fortune 500 company, with the ingenuity and energy of a healthcare independent. We are a healthcare solutions company born from the healthcare industry. We take care of hospital business, so hospitals can focus on caring for patients. Ready to be part of our solutions? Welcome to a company that gives you the resources and incentives to redefine healthcare services, with the benefits and leadership to take your career to the next step!
Responsible for processing incoming requests from various departments to bill manual and electronic claims to ensure timely and complete collection of all dollars assigned.
May require preparing and filing appeals.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Review charges, patient information, and insurance information prior to billing to minimize underpayment, denials, and re-bill attempts. Properly submit claims to primary, secondary and tertiary insurance companies with the appropriate Explanation of Benefits (EOB) attachments, if applicable.
Complete subsequent billing to third party payors to include rebills, secondary billing and/or special billing.
Work closely with the DRA/facilities to obtain any missing information required to bill the claim via the QS reporting tool.
Bill all late charges with proper billing codes, per Late Charge Workflow.
Bill claims appropriately completing billing requirements via electronic billing requirements or paper claims including any attachment of required documentation.
Review, complete and reconcile all billing reports as assigned and properly discards reports based on record retention guidelines.
Review the editor and/ or control ID for all unbilled accounts and / or rebill requests.
Notate accounts with proper activity codes for workflow back to the facilities for review of unclean claims.
Maintain and abides by all billing policies and procedures, objectives, quality assurance programs and safety & compliance standards.
Pull rejection reports (.Not) from electronic billing system daily and notes rejections details in ACE after reviewing prior ACE billing notes.
Responsible for verifying correct insurance information is loaded into demographics (if this applies to rejection) using VI, account notes and related accounts as resources.
Updates account with correct information as needed and requests rebills as needed.
Responsible for calling insurance company if rejection reports are unclear to determine next step needed for billing.
Monitor and report trends in payer rejections to management with examples of rejection responses.
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.
Intermediate Microsoft Office (Word, Excel)
Intermediate knowledge of ICD9/CPT4 codes and payor requirements
Strong knowledge of National Uniformed Billing Code, and UB-04
Good verbal and written communication skills.
Good data entry skills.
Able to work in a fast paced environment and complete high volume of EDI rejections daily handling multiple facilities
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
High School diploma or equivalent.
Some college coursework in business administration or accounting preferred
1-2 years of experience in hospital billing or
hospital collections required
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.
Office Work Environment
Conifer - Hospital RCM Services, LLC.
Tenet Healthcare - 17 months ago