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!
The Patient Account Representative is responsible for working accounts to ensure they are resolved in a timely manner. This candidate should have a solid understanding of the Revenue Cycle as it relates to the entire life of a patient account from creation to payment. Representative will need to effectively follow-up on claim submission, remittance review for insurance collections, create and pursue disputed balances from both government and non-government entities. Basic knowledge of Commercial, Managed Care, Medicare and Medicaid insurance is preferable. An effective revenue cycle process is achieved with working as part of a dynamic team and the ability to adapt and grow in an environment where work assignments may change frequently while resolving accounts with minimal assistance.
Representative must be able to work independently as well as work closely with management and team to take appropriate steps to resolve an account. Team member should possess the the following:
Perform duties as assigned in a professional demeanor, which includes interacting with insurance plans, patients, physicians, attorneys and team members as needed.
Basic computer skills to navigate through the various system applications provided for additional resources in determining account actions
Access payer websites and discern pertinent data to resolve accounts
Utilize all available job aids provided for appropriateness in Patient Accounting processes
Document clear and concise notes in the patient accounting system regarding claim status and any actions taken on an account
Maintain department daily productivity goals in completing a set number of accounts while also meeting quality standards as determined by leadership
Identify and communicate any issues including system access, payor behavior, account work-flow inconsistencies or any other insurance collection opportunities
Provide support for team members that may be absent or backlogged
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Researches each account using company patient accounting applications and internet resources that are made available. Conducts appropriate account activity on uncollected account balances with contacting third party payors and/or patients via phone, e-mail, or online. Problem solves issues and creates resolution that will bring in revenue eliminating re-work. Updates plan IDs, adjusts patient or payor demographic/insurance information, notates account in detail, identifies payor issues and trends and solves re-coup issues. Requests additional information from patients, medical records, and other needed documentation upon request from payors. Reviews contracts and identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed. Takes appropriate action to bring about account resolution timely or opens a dispute record to have the account further researched and substantiated for continued collection. Maintains desk inventory to remain current without backlog while achieving productivity and quality standards.
Perform special projects and other duties as needed. Assists with special projects as assigned, documents, findings, and communicates results.
Recognizes potential delays and trends with payors such as corrective actions and responds to avoid A/R aging. Escalates payment delays/ problem aged account timely to Supervisor.
Participate and attend meetings, training seminars and in-services to develop job knowledge.
Respond timely to emails and telephone messages as appropriate.
Ensures compliance with State and Federal Laws Regulations for Managed Care and other Third Party Payors.
Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment activity. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.
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.
Minimum typing skills of 35 wpm
Demonstrated working knowledge of PC/CRT/printer
Knowledge of function and relationships within a hospital environment preferred
Customer service skills and experience
Ability to work in a fast paced environment
Ability to receive and express detailed information through oral and written communications
Course in Medical Terminology required
Understanding of Third Party Payor requirements preferred
Understanding of Compliance standards preferred
Must be able to perform essential job duties in at least two Patient Access service areas including ED.
Uses proper negotiation techniques to professionally collect money owed by our Patients/Guarantors.
Builds and maintains collaborative relationships with both internal and external Clients that lead to more effective communication and a higher level of productivity and accuracy.
Must be able to appropriately interpret physician orders, medical terminology and insurance cards while maintaining Conifer Standards of Care.
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
High School Diploma or GED required
0 â�� 1 year in a Customer Service role.
0 â�� 1 year administrative experience in medical facility, health insurance, or related area preferred
Some college coursework is preferred
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.
Must be able to sit at computer terminal for extended periods of time
Occasionally lift/carry items weighing up to 25 lbs.
Frequent prolonged standing, sitting, and walking
Occasionally push a wheelchair to assist patients with mobility problems.
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.
Can work in patient care locations which include potential exposure to life-threatening patient conditions.
Must be available to work hours and days as needed based on departmental/system demands.
Resolves Physician's office and Patient issues. May experience extreme patient volumes and uncooperative Patients.
Primary Location: Frisco, Texas
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��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.
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.