JOB SUMMARY
Responsible for completing audits on self-pay, HIPP, UA (unidentified auto), and COB/TPL Responsible for completing audits on self-pay, HIPP, UA (unidentified auto), and COB/TPL (inventory). Responsible for identifying other potential payors including Medicaid, auto insurance, Workers' Compensation, commercial insurance, private insurance, TPL, etc. to route account appropriately in the Patient Accounting environment. Also responsible for quality review on completed Confidential Financial Statement forms and assisting patients in the correction and/or completion of deficient forms. Duties also include the audit of all applicable benefit applications for which the patient may be eligible to ensure completeness and adequacy; assists patients in correcting and/or completing such benefit applications as necessary to ensure maximum coverage and payment. Conducting home visits as needed to obtain required information.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
- Perform daily QA review of post discharge hospital admissions/ER visits to identify at risk uninsured and underinsured accounts for appropriate insurance screening activities.
- Perform daily QA review of HIPP accounts for appropriate work effort.
- Contact patient and complete field visits for the purpose of assisting with returning required COB or TPL information to clear payer claim holds.
- Review all Medicaid or QHP re-enrollments and/or new enrollments in available plans and assist patients in undertaking all necessary actions to ensure proper/successful enrollment in all available plans.
- Records and maintains complete documentation of activities performed on the inventory in Benefit Screening Portal.
- Notifies Case Management, billing, or DRA team of determinations and outcomes via verbal and written communication.
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, ABILITIESTo 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.
- Working familiarity with the rules and regulations pertaining to Federal, State and County programs, including Medicaid eligibility.
- Experience in successfully handling patient account and billing issues related to various payor obligations.
- Basic knowledge of typical audit functions, including systematically reviewing for accuracy and completeness relevant documentation.
- P/C systems literate including Windows, and Microsoft Outlook, Excel and Word programs.
- Ability to work independently.
- Excellent oral and written communication skills, as well as the clear understanding of the English language. Knowledge and familiarity with common medical terminology used in case management, billing, and/or medical insurance coding.
- Detail oriented, with strengths in dealing with multiple facilities, Supervisors, and Hospital platforms.
- Ability to prioritize and manage multiple tasks with efficiency.
Include minimum education, technical training, and/or experience required to perform the job.
- High School diploma or equivlent
- Preferred 2 years work experience with Social Services or Hospital Admitting or related area
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.
- Ability to sit and work at a computer terminal for extended periods of time.
- Must be able to walk through a hospital environment, including across broad campus settings and Emergency Department environments, and visit patients at bedside.
- Travel may be required to the patient’s house
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.
- Both Hospital and Office facilities, in direct contact with Patients and Staff
OTHER
- Some travel may be required
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!
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