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 validating dispute reasons following Explanation of Benefits (EOB) review, escalating payment variance trends or issues to NIC management, and generating appeals for denied or underpaid claims.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Validates denial reasons and ensures coding in DCM is accurate and reflects the denial reasons.
Coordinate with the Clinical Resource Center (CRC) for clinical consultations or account referrals when necessary,
Generate an appeal based on the dispute reason and contract terms specific to the payor.
Researches contract terms/interpretation and compiles necessary supporting documentation for appeals, Terms & Conditions for Internet enabled Managed Care System (IMaCS) adjudication issues, and referral to refund unit on overpayments.
Performs research and makes determination of corrective actions and takes appropriate steps to code the DCM system and route account appropriately.
Escalates denial or payment variance trends to NIC leadership team for payor escalation.
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 understanding of Explanation of Benefits form (EOB), Managed Care Contracts, Contract Language and Federal and State Requirements
Intermediate knowledge of hospital billing form
Intermediate understanding of ICD-9, HCPCS/CPT coding and medical terminology
Intermediate Microsoft Office (Word, Excel) skills
Advanced business letter writing skills to include correct use of grammar and punctuation.
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience required to perform the job.
High School Diploma or equivalent, some college coursework preferred
3 - 5 years experience in a hospital business environment performing billing and/or collections
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 - 2 years ago