JOB SUMMARY
To research, investigate and attempt to resolve patient disputes, whether originating from the patient or a party(ies) representing the patient, and handle inquiries from state and federal regulatory agencies in a timely and accurate manner. All the while, the IRS rep will comply with all state, federal, FCRA, FDCPA, HIPAA and Tenet guidelines. During investigation, the IRS rep may come across risk management issues and/or clinical issues, etc.; the need may arise to bring the situation to the attention of another department and/or facility for advice or to hand-off the dispute.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
- Investigation and resolution of disputes ensuring compliance with all applicable federal and state laws and regulations, as well as compliance to all Tenet policies, procedures, and reporting requirements. Types of disputes to be investigated and resolved, include, but are not limited to claims of:
- Inappropriate/incomplete insurance billing
- Health Insurance Portability and Accountability Act (HIPAA)
- Fair Debt Collection Practices Act (FDCPA)
- Fair Collection Practices Act (FCRA)
- Emergency Medical Treatment and Active Labor Act (EMTALA)
- Quality of care (including, inappropriate/inadequate diagnosis/care, questionable services, or services not received)
- Spousal parental liability
- Inappropriate/incomplete insurance billing
- Account explanation
- Proposed accord and satisfaction or restrictive endorsement/conditional payment.
- Disputes escalated to Tenet executives, Legal, and/or National Ethics Compliance Line.
- Handling of disputes received via Billing Inbox
- Work directly with patients, attorneys, government agencies, consumer protection groups, facilities (Admitting Manager, Director of Patient Services, Hospital Compliance Officer, Risk Manager, HIM Director, etc.), PFS Client Services Directors, Compliance, Security, Operations, Tenet Executive offices, and credit reporting agencies (CRAs) to resolve and respond to disputed issues in writing.
- Analyze each specific dispute to determine what the resolution of such dispute should be. Process to include all necessary research in order to make proper determination for resolution of dispute.
- Back up to field calls from Tenet’s toll-free line on consumer credit profiles answering questions and complaints pertaining to the facility’s soft inquiry, Central Financial Control’s hard inquiry and/or Central Financial Control’s derogatory reporting onto a consumer’s credit profile.
- Work with management and/or Perot systems to resolve any system/process issues identified through investigation process; including opening any necessary tickets with Perot systems for resolution of such issues identified.
- Investigate and resolve all claims of identity theft and/or theft of services regardless of LOB by working with consumer, consumer’s representative (i.e. attorney), facility, credit reporting agencies (CRAs), and/or police/sheriff’s department.
- Other duties as assigned
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.
- Strong decision-making skills
- Ability to exercise sound judgment and common sense in resolving all issues presented in dispute as well as issued identified during investigation.
- Ability to act independently as well as seek guidance when unsure as to how to handle a dispute, especially when with the ability to identify the different between interpretation of the law and excising solid judgment.
- Excels in Interpersonal, written, and verbal communication skills
- Thorough understanding of all federal and state laws and regulations, such as, HIPAA, FDCPA, FCRA, and EMTALA but not limited to.
- Must be able to lift at least 10 pounds
- MS Office proficient
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.
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience required to perform the job.
- College degree, however, not required
- Minimum of 4 years of healthcare industry (preferable facility/provider) experience.
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.
- 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.
- Office environment
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.
Required: 5 - 7 years experience of progressively more responsible financial and leadership positions in a healthcare environment
Certifications: Physical Demands:
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