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 first level management of patient non-government and specialty billing activities in the National Insurance Center (NIC).
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Ensures that all Claims are processed and billed in an efficient and timely manner.
Ensures compliance with state and federal law regulations for Managed Care and other third party payors.
Develops or approves recommendations to change billing systems, policies and procedures; ensures timely and accurate implementation.
Implements strategies for improving the clean claim rate for facilities. Works with other managers and/or supervisors to build and implement bridge-routines so that claims are submitted correctly with minimum disruption to cash flow.
Ensures all billing reports are worked timely to optimize cash flow; Monitors daily/weekly billing productivity and efficiency of billers through CPQ .
Ensures inventory is managed to eliminate/reduce backlog of unprocessed claims in the Editors ,CID's or biller's desk.
Monitors Released Paper Claims Reports to see if payors can be mapped electronically; Monitors Field Edit Detail Reports to locate bridge routines which can be implemented to prevent unclean claims.
Ensures billing system, control ID's, and Ace Desks are current.
Work Daily lock-down fields with the editor (HFLS)
Daily review and approval of balance reports.
Complies and ensures all SOX /Compliance protocols are met and reporting completed within the required time frames.
Monitors monthly quality performance, completing timely quality reviews of employees work.
Identifies areas of regulatory and industry changes and provides timely employee training to ensure accurate billing is attained.
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
Working knowledge of National Uniformed Billing Code, CPT/HCPC, ICD-9 and UB-04
Intermediate knowledge of HIPAA guidelines
Intermediate writing skills
Ability to multi-task
Strong leadership and organizational skills
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
4 year college degree in Business or Healthcare Administration preferred
3 -5 years experience providing leadership and management direction related to Billing and follow-up of Managed Care and Commercial processes within a multi-facility environment
Experience as a Patient Accounts Supervisor preferred
Experience with business process redesign desirable
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
Moderate travel required
Must complete billing and reimbursement training within 30 days of hire or each refresher year date (1/31). The passing score for completion is 80%.
238-Conifer - Anaheim - CA
- 2 years ago - save job