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!

JOB SUMMARY

The primary purpose of the REP, PHYS SVC AR IV 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 IV 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 and analysis, 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

• Analyze weekly denial reports to spot trends; assess opportunities to improve internal workflows within entire revenue cycle

• Maintain internal logs (Excel format) and compile system reports

• Assist in employee training and mentorship; perform quality assurance checks on team members

• Contact client for missing data elements or confirmation of information

• Participate in system testing related to upgrades and enhancement.

• Others may be assigned.
  

EDUCATION / EXPERIENCE

• High school diploma or equivalent
• 4-6 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
• Fluent knowledge of entire revenue cycle process
• 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
• Extensive skill with Microsoft Office applications
• Strong written and verbal communication skills
• Excellent analytical and problem solving skills
• Ability to multi-task and recognize trends to effectively work A/R
• Ability to work independently and handle sensitive issues with confidentiality
• 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 � Expresses ideas clearly and succinctly with small or large audiences. Listens attentively to speaker�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 � 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 � Ensures that clients have a positive experience. Responds to clients in a timely manner. Demonstrates tact and empathy when responding to clients.
• Quality, Productivity and Technical Ability � Maintains acceptable performance standards set as department goals for the assigned position.
• Respects Others - Displays sensitivity to the needs and concerns of others. Interacts with others in an open, non-threatening manner.
• Shows Reliability � 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 applicant�s or employee�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.