Spec, AR Ops Lead

Conifer Health Solutions • Frisco, TX

3d • Remote

About The Position

Responsible for providing assistance, coaching and training to staff members, including new hires. Support and assist the Team, the Supervisor and Management with complex inventory and issue resolution. Responsible for all aspects of the billing, follow-up and collection activity for all payers. May maintain a large dollar inventory desk or complex accounts as well as serve as just-in-time staffing, working inventory for team members that may be absent or backlogged. May assist with special projects assigned by management, including acting as a point of contact for internal operational questions.

Assist with training and development of new hires and subsequent training needs. Provide assistance, coaching and training to staff members. Provide enhanced training and assist staff with techniques to increase production, quality and collections. Participate in the new hire peer interviewing process Attend various conference calls, webinars or advanced training to provide assistance to the team members. Respond timely to emails and telephone messages from the staff, management and the client Assists with special projects as assigned; documents findings and communicates results. Assist management in keeping projects on track for timely delivery. Report the flow of day-to-day operations and the impact of daily challenges for supervisor review Utilizes high level problem solving, with a focus on compliance, in an effort to seek out and identify system and operational issues. Identify chronically recurring problems and provide creative solutions to Leadership and business partners 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. Work required reports (daily, weekly, monthly). Research each account using company patient accounting applications and internet resources. Conducts appropriate account activity on uncollected balances with contacting third party payors and/or patients via phone, e-mail, or online. Updates plan IDs, adjusts patient or payor demographic/insurance information, notates account in detail, and solves recoup issues. Request additional information from patients, medical records, and other needed documentation upon request from payors. Reviews all existing documentation including but not limited to UB, IB, Explanation of Benefits (EOB), and Managed Care Contracts to verify claim balance calculation; ensures integrity in supporting documentation. Verifies in system that accounts have been adjudicated correctly once settled. If needed, adjust accounts per Legal request. Identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed. Take appropriate action to bring about account resolution timely and open a dispute record to have the account further researched and substantiated for continued collection, including completion of technical appeals. Maintains desk inventory to remain current without backlog while achieving productivity and quality standards.

Requirements

• Knowledge of Medical Record documentation
• Knowledge of writing disputes (appeals 1 st ,2 nd 3 rd level)
• Ability to work independently and exercise good judgement and independence to problem solve.
• Advanced knowledge of Excel and Proficient
• Advanced knowledge of all Microsoft Office Products
• Ability to multitask, meet deadlines and adapt to change
• Ability to speak professionally to help drive resolution for resolving complex claims
• Proficient knowledge of Microsoft Office
• Strong organizational skills
• Strong Knowledge of coding terminology such as HCPCS, Diagnosis & ICD-10, DRG & Revenue Codes
• Intermediate understanding of Explanation of Benefits form (EOB), Managed Care Contracts, Contract Language and Federal and State Requirements
• Intermediate knowledge of hospital billing form requirements (UB-04)
• Intermediate understanding of ICD-9, HCPCS/CPT coding, and medical terminology
• Intermediate writing skills to include correct use of grammar and punctuation.
• Intermediate writing skills
• Intermediate analytical and math skills
• Ability to coordinate accounts and record detailed information
• Ability to research and work independently
• Ability to work in high volume environment at a fast pace
• Ability to communicate in a professional manner
• High school diploma or equivalent
• 3-5 years of experience in medical billing, collections, appeals, legal department and/or contract interpretation

Nice To Haves

• Some college helpful

Responsibilities

• Work independently as well as work closely with management and team to take appropriate steps to resolve an account.
• Perform duties as assigned in a professional demeanor, which include interacting with insurance plans, patients, physicians, attorneys, and team members as needed.
• Have 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
• Conduct high-level problem solving with a focus on compliance and Revenue Cycle.
• Assist with training and development of new hires and subsequent training needs.
• Provide assistance, coaching and training to staff members.
• Provide enhanced training and assist staff with techniques to increase production, quality and collections.
• Participate in the new hire peer interviewing process
• Attend various conference calls, webinars or advanced training to provide assistance to the team members.
• Respond timely to emails and telephone messages from the staff, management and the client
• Assists with special projects as assigned; documents findings and communicates results.
• Assist management in keeping projects on track for timely delivery.
• Report the flow of day-to-day operations and the impact of daily challenges for supervisor review
• Utilizes high level problem solving, with a focus on compliance, in an effort to seek out and identify system and operational issues.
• Identify chronically recurring problems and provide creative solutions to Leadership and business partners
• 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.
• Work required reports (daily, weekly, monthly).
• Research each account using company patient accounting applications and internet resources.
• Conducts appropriate account activity on uncollected balances with contacting third party payors and/or patients via phone, e-mail, or online.
• Updates plan IDs, adjusts patient or payor demographic/insurance information, notates account in detail, and solves recoup issues.
• Request additional information from patients, medical records, and other needed documentation upon request from payors.
• Reviews all existing documentation including but not limited to UB, IB, Explanation of Benefits (EOB), and Managed Care Contracts to verify claim balance calculation; ensures integrity in supporting documentation.
• Verifies in system that accounts have been adjudicated correctly once settled.
• If needed, adjust accounts per Legal request.
• Identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed.
• Take appropriate action to bring about account resolution timely and open a dispute record to have the account further researched and substantiated for continued collection, including completion of technical appeals.
• Maintains desk inventory to remain current without backlog while achieving productivity and quality standards.

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.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED