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 performing payment follow-up activities on patient accounts as assigned.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
appropriate account activity on final billed claims by contacting government agencies, third party payors, and patients/guarantors via phone, e-mail, or online. Continues collection activity until account is resolved, sent to Legal, or disputed. Responsible for maintaining inventory on desks with no backlog. Ensure daily productivity standards of assigned accounts are met.
Requests additional information from Patients, Medical Records, and others upon request from payors. Reviews contracts and identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed.
Updates Plan IDs and Patient/Payor demographic information; posts notes and memos to accounts; identify payor issues and trends; and solve recoup issues. Returns accounts to Appeal Writers for next level appeals as needed.
Identifies payor trends in payment delays and escalates issues to Supervisor.
Recognizes potential delays with payors such as corrective actions and responds avoid A/R aging. Escalates payment delays/ problem aged account timely to Supervisor.
Perform special projects and other duties as needed. Assists with special projects by utilizing excel spreadsheets, and must be able to communicate results.
Ensures compliance with State and Federal Laws Regulations for Managed Care and other Third Party Payors.
Conducts collection activity on previously appealed claims by contacting government agencies, third party payers via phone, email, or online. Provides ongoing appropriate collection activity on appeals until the payer has responded to the appeal.
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, collections) procedures and policies
Intermediate skill in
Microsoft Office (Word, Excel)
Ability to learn hospital systems - ACE, VI Web, IMaCS, OnDemand quickly and fluently
Ability to communicate in a clear and professional manner
Must have good oral and written skills
Strong interpersonal skills
Above average analytical and critical thinking skills
Ability to make sound decisions
Has a full understanding of the
Managed Care collections, Intermediate knowledge of Manage Care contracts, Contract Language and Federal and State requirements.
Familiar with terms such as HMO, PPO, IPA and Capitation and how these payors process claims.
Intermediate understanding of
Intermediate understanding of
Hospital billing form requirments ( UB04) and familiar with the HCFA 1500 forms.
Ability to problem solve, prioritize duties and follow-through completely with assigned tasks.
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
2-3 years medical claims and/or hospital collections experience
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.
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
238-Conifer - Anaheim - CA
Tenet Healthcare - 23 months ago