As a part of the Tenet and Catholic Health Initiativesfamily, Conifer Health brings 30 years of healthcare industry expertise toclients in more than 135 local regions nationwide. We help our clientsstrengthen their financial and clinical performance, serve their communitiesand succeed at the business of healthcare. Conifer Health helps organizationstransition from volume to value-based care, enhance the consumer and patienthealthcare experience and improve quality, cost and access to healthcare. Areyou ready to be part of our solutions? Welcome to the company that gives you the resources and incentives toredefine healthcare services, with a competitive benefits package andleadership to take your career to the next step!
Responsible for validating dispute reasons followingExplanation of Benefits (EOB) review, escalating payment variance trends orissues to NIC management, and generating appeals for denied or underpaidclaims.
ESSENTIAL DUTIES ANDRESPONSIBILITIES
Include thefollowing. Others may be assigned.
Validate denial reasons and ensurescoding 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 disputereason and contract terms specific to the payor. This includes onlinereconsiderations.
Follow specific payer guidelines forappeals submission
Escalate exhausted appeal efforts forresolution
Work payer projects as directed
Research contract terms/interpretationand compile necessary supporting documentation for appeals, Terms &Conditions for Internet enabled Managed Care System (IMaCS) adjudicationissues, and referral to refund unit on overpayments.
Perform research and makes determinationof corrective actions and takes appropriate steps to code the DCM system androute account appropriately.
Escalate denial or payment variance trends to NIC leadership team forpayor escalation
KNOWLEDGE, SKILLS, ABILITIES
To perform this jobsuccessfully, an individual must be able to perform each essential dutysatisfactorily. The requirements listed below are representative of theknowledge, skill and/or ability required. Reasonable accommodations may be madeto enable individuals with disabilities to perform the essential functions.
Intermediate understanding ofExplanation of Benefits form (EOB), Managed Care Contracts, Contract Languageand Federal and State Requirements
Intermediate knowledge of hospital billingform requirements (UB-04)
Intermediate understanding of ICD-9,HCPCS/CPT coding and medical terminology
Intermediate Microsoft Office (Word,Excel) skills
Advanced business letter writing skillsto include correct use of grammar and punctuation.
Include minimumeducation, technical training, and/or experience preferred to perform the job.
High School Diploma or equivalent, somecollege coursework preferred
3 - 5 years of experience in a hospitalbusiness environment performing billing and/or collections
The physical demandsdescribed here are representative of those that must be met by an employee tosuccessfully perform the essential functions of this job. Reasonableaccommodations may be made to enable individuals with disabilities to performthe essential functions.
Ability to sit and work at a computerterminal for extended periods of time
The work environmentcharacteristics described here are representative of those an employeeencounters while performing the essential functions of this job. Reasonableaccommodations may be made to enable individuals with disabilities to performthe essential functions.
Call Center environment with multipleworkstations in close proximity
Job: Conifer Health Solutions
Primary Location: Lebanon, New Hampshire
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâs or employeeâs 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.