Denial Management Representative - Remote

Job Summary

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.

About the Role

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 Following

Responsibilities

• 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.
• Performs special projects and other duties as needed.
• Affords support for team members that may be absent or backlogged.

Requirements

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.

• Thorough understanding of the revenue cycle process, from patient access (authorization, admissions) through Patient Financial Services (billing, insurance appeals, collections) procedures and policies.
• Intermediate skill in Microsoft Office (Word, Excel).
• Ability to learn hospital systems – ACE, VI Web, IMaCS, OnDemand quickly and fluently.
• Ability to communicate in a clear and professional manner.
• Strong interpersonal skills.
• Above average analytical and critical thinking skills.
• Ability to make sound decisions.
• Familiar with terms such as HMO, PPO, IPA and Capitation and how these payors process claims.
• Intermediate understanding of EOB.
• Intermediate understanding of Hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms.
• Ability to problem solve, prioritize duties and follow-through completely with assigned tasks.

Qualifications

High School diploma or equivalent. Some college coursework in business administration or accounting preferred. 1-4 years medical claims and/or hospital collections experience. Minimum typing requirement of 45 wpm.

Physical Demands

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.

Office/Team Work Environment: Ability to sit and work at a computer terminal for extended periods of time.

Work Environment: Call Center environment with multiple workstations in close proximity.

Benefits

• Medical, dental, vision, disability, and life insurance.
• Paid time off (vacation & sick leave) – min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match.
• 10 paid holidays per year.
• Health savings accounts, healthcare & dependent flexible spending accounts.
• Employee Assistance program, Employee discount program.
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.

Compensation

$15.80 - $23.70 per hour. Compensation depends on location, qualifications, and experience. Position may be eligible for a signing bonus for qualified new hires, subject to employment status.

Employment Practices

Conifer observed holidays receive time and a half. 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. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: http://www.uscis.gov/e-verify