Conifer Health Solutions is a leading healthcare business process management services provider working to improve operational performance for more than 600 clients so they can support financial improvement, enhance the patient experience, and drive value-based performance. Through our revenue cycle management, patient communications, and value-based care solutions, we empower healthcare decision makersï¿½hospitals, health systems, physicians, self-insured employers, and payersï¿½to better connect every point of care and wellness management.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!
Responsible for providing direct support to internal and subcontracted external legal resources engaged in the collection and recovery of managed care and/or Workerï¿½s Compensation claims.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Acts as liaison between the Business Office, Legal Department and outside counsel regarding outstanding litigation (i.e. Vendors)
Coordinates legal analysis for denied, underpaid and unpaid managed care accounts for legal referral; Compiles records and documentation for internal and external attorneys such as process documentation, copies of original contracts, etc. to be used in litigation.
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.
Works with Legal Department to file bankruptcy notifications on payers. May file liens on auto accident patients to state interest in claim.
Verifies in system that accounts have been adjudicated correctly once settled. If needed, adjust accounts per Legal request.
Works required reports (daily, weekly, monthly) to ensure legal payer issues are referred in a timely manner.
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.
Intermediate writing skills
Intermediate Microsoft Word and Excel 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
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
High school diploma or equivalent
Some college helpful
3-5 yearsï¿½ experience in medical billing, collections, appeals, legal department and/or contract interpretation
Job: Conifer Health Solutions
Primary Location: Frisco, Texas
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��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.
Internal Number: 1905041495
About Conifer Health Solutions
“Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans.