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Insurance Plan Specialist

  • Job ID 1705046179
  • Date posted 11/17/2017
Description:

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!

JOB SUMMARY

To review and research payment account adjudication, billing results, and disputed claim patterns for assigned payers. Review and validate claim issues and prepares documents to support/present in payer meetings. Work closely with internal and external stakeholders to ensure the expected reimbursement (Med-Assets), Billing, and Disputed Claims systems supporting assigned payer processes are working properly to efficiently adjudicate claims. Assists stakeholders in all necessary functions for analyzing payer performance and providing reports to quantify bulk issues.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Others may be assigned.

  • Performs high level contract overview to ensure accuracy of contract terms and conditions.
  • Solid understanding of reimbursement methodologies to review variances to expected reimbursement (debit and credit balances) based on established guidelines.
  • Ability to analyze, trend and escalate issues as needed to the appropriate stakeholders.
  • Prepares groups of accounts based on logged information to provide stakeholders with clean actionable issues to drive payer results.
  • Works required reports (daily, weekly, monthly) to ensure claims processing integrity based on established guidelines provided by management.
  • Coordinate efforts with stakeholders to drive changes in auto adjudication, aging and cycle time.
  • Leads and participates in meetings as needed.
  • Provides feedback to operations and other stakeholders regarding payer trend status resolution.
  • Provides concise documentation and reports to all stakeholders. Assists in special projects to drive desired payer results.
  • Assists in training of all team members and stakeholders as needed.
  • Review bulletins and notifications from the payer on a timely basis and assess for business impact.
  • Prepare related communications to notify stakeholders.


Qualifications:

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 knowledge of managed care and other healthcare contract language
  • Intermediate understanding of ICD-9, HCPCS/CPT coding, medical terminology and hospital billing form requirements (UB-04)
  • Intermediate skills in Microsoft Excel to create pivot tables and perform v-lookup function
  • Intermediate knowledge of query writing applications and data validations desired
  • Intermediate knowledge of Contract Adjudication applications (Med-Assets)
  • Intermediate knowledge of patient accounting principles
  • Demonstrated ability to detect patterns in large volumes of data
  • Strong communication skills (verbal and written)
  • Strong contract interpretation skills
  • Strong relationship building and collaboration skills

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience required to perform the job.

  • 4 year college degree preferred; High School diploma or equivalent required
  • 2-4 years of experience working with Patient Financial Services, Managed Care and other contracted payors in a healthcare operations environment
  • 1-2 years of experience in analysis of payer trends

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
Job:  Insurance
Primary Location:  Frisco, Texas
Job Type:  Full-time
Shift Type:  Days

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 and Work Opportunity Tax Credit (WOTC) programs. Follow the links below for additional information.


E-Verify: http://www.uscis.gov/e-verify
WOTC: https://www.doleta.gov/business/incentives/opptax

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