Denial Management Representative - Remote
Conifer Health Solutions, Frisco, TX, United States
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. The representative will need to effectively follow up on claim submission, remittance review for insurance collections, and 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 by 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.
Essential Duties and Responsibilities
Research each account using company patient accounting applications and internet resources. Conduct appropriate account activity on uncollected account balances, contacting third party payors and/or patients via phone, e‑mail, or online. Problem‑solve issues and create resolutions that bring in revenue, eliminating re‑work. Update plan IDs, adjust patient or payor demographic/insurance information, notate account in detail, identify payor issues and trends, and solve re‑coupage issues. Request additional information from patients, medical records, and other needed documentation upon request from payors. Review contracts and identify billing or coding issues, and request re‑bills, secondary billing, or corrected bills as needed. Take appropriate action to bring about account resolution in a timely manner or open a dispute record for further research.
Perform special projects and other duties as needed. Assist with special projects as assigned, documenting findings and communicating results.
Recognize potential delays and trends with payors such as corrective actions and respond to avoid A/R aging. Escalate payment delays or problem‑aged accounts timely to Supervisor.
Participate in meetings, training seminars and in‑services to develop job knowledge.
Respond timely to emails and telephone messages as appropriate.
Ensure compliance with State and Federal Laws, Regulations for Managed Care and other Third Party Payors.
Knowledge, Skills, and Abilities
Thorough understanding of the revenue cycle process from patient access through Patient Financial Services 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 oral and written skills.
Strong interpersonal skills.
Above‑average analytical and critical thinking skills.
Ability to make sound decisions.
Full understanding of Commercial, Managed Care, Medicare, and Medicaid collections, intermediate knowledge of Managed Care contracts, contract language, and Federal and State requirements for government payors.
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 familiarity with the HCFA 1500 forms.
Ability to problem‑solve, prioritize duties, and follow through completely with assigned tasks.
Education and Experience
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
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.
Vaccination Requirement 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. This may include, but is not limited to, the COVID‑19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.
Compensation and Benefit Information
Pay: $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.
Conifer observed holidays receive time and a half.
Benefits
Medical, dental, vision, disability, and life insurance.
Paid time off (vacation & sick leave) – minimum of 12 days per year, accruing at a rate of approximately 1.84 hours per 40 hours worked.
401(k) 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.
Employment Practices 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. The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations.
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Essential Duties and Responsibilities
Research each account using company patient accounting applications and internet resources. Conduct appropriate account activity on uncollected account balances, contacting third party payors and/or patients via phone, e‑mail, or online. Problem‑solve issues and create resolutions that bring in revenue, eliminating re‑work. Update plan IDs, adjust patient or payor demographic/insurance information, notate account in detail, identify payor issues and trends, and solve re‑coupage issues. Request additional information from patients, medical records, and other needed documentation upon request from payors. Review contracts and identify billing or coding issues, and request re‑bills, secondary billing, or corrected bills as needed. Take appropriate action to bring about account resolution in a timely manner or open a dispute record for further research.
Perform special projects and other duties as needed. Assist with special projects as assigned, documenting findings and communicating results.
Recognize potential delays and trends with payors such as corrective actions and respond to avoid A/R aging. Escalate payment delays or problem‑aged accounts timely to Supervisor.
Participate in meetings, training seminars and in‑services to develop job knowledge.
Respond timely to emails and telephone messages as appropriate.
Ensure compliance with State and Federal Laws, Regulations for Managed Care and other Third Party Payors.
Knowledge, Skills, and Abilities
Thorough understanding of the revenue cycle process from patient access through Patient Financial Services 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 oral and written skills.
Strong interpersonal skills.
Above‑average analytical and critical thinking skills.
Ability to make sound decisions.
Full understanding of Commercial, Managed Care, Medicare, and Medicaid collections, intermediate knowledge of Managed Care contracts, contract language, and Federal and State requirements for government payors.
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 familiarity with the HCFA 1500 forms.
Ability to problem‑solve, prioritize duties, and follow through completely with assigned tasks.
Education and Experience
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
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.
Vaccination Requirement 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. This may include, but is not limited to, the COVID‑19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.
Compensation and Benefit Information
Pay: $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.
Conifer observed holidays receive time and a half.
Benefits
Medical, dental, vision, disability, and life insurance.
Paid time off (vacation & sick leave) – minimum of 12 days per year, accruing at a rate of approximately 1.84 hours per 40 hours worked.
401(k) 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.
Employment Practices 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. The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations.
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