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Founded in 2008, Conifer Health Solutions is an independent healthcare services company that specializes in managed services for health systems. Conifer Health Solutions employs th
Patient Account Representative
Location
United States
Posted
46 days ago
Salary
$16 - $24 / hour
Seniority
Mid Level
Job Description
Patient Account Representative
Conifer Health Solutions
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. 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 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. 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. - 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 - Must have good oral and written skills - Strong interpersonal skills - Above average analytical and critical thinking skills - Ability to make sound decisions - Has a full understanding of the 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 familiar with the HCFA 1500 forms. - Ability to problem solve, prioritize duties and follow-through completely with assigned tasks. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience preferred to perform the job. - 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 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. - Call Center environment with multiple workstations in close proximity 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! Compensation and Benefit Information Compensation - 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 Conifer offers the following benefits, subject to employment status: - 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. Our Culture is Rooted in the Communities We Serve Service is at the heart of Conifer Health's values and our company's culture. Our team members are dedicated to making a positive impact in the places where they live and work. Together, we commit to foster good health, combat hunger and connect humanity. The power of local volunteerism combined with charitable giving helps build the strong, healthy communities we want for ourselves and our clients. We Deliver Better Business Outcomes for Clients Consumers are demanding greater transparency on cost and quality, and healthcare organizations and self-insured employers are focusing more on wellness and prevention. Achieving market leadership requires excelling at reimbursement competencies and risk-based capabilities. Aligning with a proven partner with deep expertise in health system reimbursement and risk-based administration can accelerate success and improve your patient, operational and financial outcomes. Real People and Real Lives Inspire Us to Serve for Better We're experts at the business of healthcare. But what truly sets us apart is how we deliver revenue cycle management and value-based care services. Serve for Better is a simple, but powerful mindset for how all of our team members act toward any patient, client, or fellow team member. Serve for Better means we are focused on Empathy, Quality, Completeness and Experience. Together, We Make Better Health Possible Conifer Health has been providing managed services to health systems, their health plans and managed populations for more than 35 years. Our purpose is to provide the foundation for better health. Serving Within Our Communities Service is at the heart of Conifer Health's values. We are proud of the dedication of our employees to make a positive impact in the places where they live and work. Conifer Health provides employees a variety of ways to give their time and talent to the organizations that mean the most to them. Focusing on Growth Conifer Health supports team members through Conifer University. Each field of learning is designed to focus on a unique team member need.
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