Tenet Healthcare

Analyst

• Provide day-to-day operational support and routine maintenance for ambulatory applications
• Respond to end user requests
• Perform troubleshooting of complex issues related to system functionality and data integrity
• Follow and support standard testing methodologies for updates, changes, and patches
• Provide high quality documentation related to new or modified system configuration and support
• Communicate with vendors and other support services to install/support systems
• Maintain, check, test, troubleshoot and update all data interfaces and other system inputs/outputs
• Work directly with clinicians, staff and corporate resources to support application workflows and serve as a liaison with vendors when escalation is needed to align clinical and IT standards with department workflow, processes, and policies
• Participation in an on-call rotation
• Manage administration and maintenance of assigned information systems, including installations, conversions and upgrades
• Advise or participate in system-wide projects and reported issues
• Provide oversight of the development, delivery, and support of technology solutions to achieve optimal patient safety, financial, and workflow efficiencies
• Other duties as assigned

Senior Application Analyst – Ambulatory

Account Manager

• Responsible for physician and physician practice outreach to grow USPI center case volume and service lines
• Plan and conduct in-person visits with proceduralist physician offices and key stakeholders
• Evaluate and interpret physician referral patterns and market dynamics
• Develop business development strategies for target markets and services in collaboration with leaders
• Research providers to understand facility selection decision-making and related relationships
• Conduct face-to-face sales meetings to communicate center capabilities, processes, patient experience, and safety outcomes
• Complete follow-up meetings to understand physicians’ needs and obstacles to growth
• Communicate client feedback and partner with facility resources to facilitate credentialing and onboarding of new physicians
• Prepare and present sales reports measuring case volume growth, trends, and opportunities
• Modify and execute business development tactics based on provider and facility feedback
• Maintain knowledge of market hospital, ambulatory surgery, and provider landscape
• Document all client engagement daily in the defined CRM tool, including outcomes and required follow-up
• Support implementation of service line expansion, extended hours, case cancellation recapture, and related initiatives
• Perform all duties with high ethical standards and strict adherence to company policies and procedures.

Partnership Manager

Bilingual

• The Patient Engagement Representative handles day-to-day operations in a contact center, supporting patient acquisition and retention strategies via multi-channel communications (inbound, outbound, web chats, email, SMS).
• Inbound support includes answering inquiries promptly, adherence to scripting, and eligibility determination for care coordination and service line navigation.
• Provide physician referrals in accordance with Stark Law and document referral criteria.
• Provide event details and secure registration; process payments electronically when applicable.
• Handle payer contract negotiation calls and data breach calls per FAQ scripting and escalation paths.
• Navigate multiple systems to resolve requests; maintain quality measures and document demographic data and consent.
• Document and refer unresolved issues to appropriate department/client.
• Handle, document, and escalate patient complaints with professional demeanor.
• Handle multi-language calls utilizing interpreter services.
• Transfer callers to Post Call Satisfaction Survey.
• Maintain productivity by handling expected handle times and after-call work.
• Outbound duties include reminder calls for appointments; provide prep instructions; email communications; outreach to targeted populations; not telemarketing; generate SMS content; contact provider offices to validate information; additional support as needed.

Patient Engagement Representative, Bilingual

Manager

• Protect company interests and advance business objectives related to HIM coding
• Manage a team conducting coding quality reviews of Tenet TPR coded accounts
• Identify education opportunities based on reviews and develop/deliver educational content
• Perform annual Pro-Fee QA audits of assigned providers (E&M, CPT, ICD10, Modifiers) and assigned TPR GBC or Vendor coders
• Conduct Pre-Bill Clearance for all new assigned providers
• Perform focused QA audits as assigned (e.g., OIG workplan, payor review notifications)
• Provide provider/coder/practice coding education based on audit findings and trending
• Conduct claim denial root cause analysis and develop/deliver education to prevent denials
• Serve as coding education resource for providers, coders, practice and staff queries
• Communicate and present findings effectively in person and via online platforms
• Supervise, schedule and assess performance of coding auditor/educator FTEs domestically and in the GBC
• Coordinate and monitor Coding Manager meetings, assignments and activities as assigned by Senior Director of Coding and CDI
• Remote based role requiring travel 0-10%

Coding Manager, Audits & Education

Auditor

• Conducts coding and documentation quality reviews and generates responses for cases denied by commercial and government payors to ensure claims coded and billed in accordance with coding guidelines, standards, regulations and payor guidelines.
• Performs analysis on clinical documentation, evidence based criteria application outcome, physician documentation, physician advisor input and complete review of the medical record related to clinical denials.
• Formulates and submits letters of appeal and creates effective appeals using clinical documentation supported by guidelines and evidence-based medicine.
• Performs reviews of accounts denied for DRG validation and DRG downgrades.
• Documents in appropriate denial tracking tool (ACE) and maintains/distributes reports to leadership.
• Identifies payment methodology of accounts including Managed Care contract rates, Medicare and State Funded rates, Per-Diems, DRG’s, Outlier Payments, and Stop Loss calculations.
• Collaborates with Physician Advisors and CRC leadership when documentation-specific areas of concern are identified.
• Maintains expertise in clinical areas and current trends in healthcare, inpatient coding and reimbursement methodologies and utilization management specialty areas.

CRC Coding Auditor

Financial Planning and Analysis

• Responsible for creating a positive patient experience by accurately and efficiently handling day-to-day operations relating to Financial Clearance and Scheduling
• Completes both scheduling and registration functions with the patient for an upcoming visit during one call
• Scheduling: timely scheduling, provide appointment-related information (prep, directions, order management)
• Financial Clearance: verify patient demographic, insurance information and secure payment of patient financial liability/perform collection efforts
• If assigned to Order Management: verify order completeness and match scheduled procedure; index and export physician orders to correct account number
• If assigned to complex Pre-Reg: collect and verify patient demographic and financial data, determine financial responsibility and secure pre-payment/perform collection efforts
• Create a complete pre-registration account for upcoming inpatient/surgical admission
• Complete pre-certification requirements by obtaining authorization from insurer and/or healthcare facility
• Other duties as assigned based on departmental needs

Financial Clearance

Operations

• Responsible for managing a collections department including staffing, training, and strategy.
• Reviews monthly reports that are prepared by site management, surfaces relevant issues, analyzes and develops corrective action plans.
• Oversees hiring in the region and provides training/coaching to branch supervision.
• Ensures accurate and timely documentation of all work efforts on the required forms set forth by company policies and procedures.
• Establishes procedures for daily operations (with input form site management)
• Supervises, plans, organizes, and directs the daily activities of the department and its collection functions.
• Anticipates future changes/needs, creating strategic and operational plans for addressing them.
• Resolves corporate interface problems which cannot be resolved at the supervisory level.
• Develops operational targets in collaboration with site management.
• Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
• Direct Reports: 2 – 3 Supervisors, 3-4 Support Staff
• Indirect Reports: 15-20 Collectors and Account Specialists
• Must be able to work in sitting position, use computer and answer telephone
• Call Center environment with multiple workstations in close proximity
• 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.
• 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.
• Compensation: Pay: $72,509.00 - $108,763.00 annually. Position may be eligible for an Annual Incentive Plan bonus of 10%-25% depending on role level. Management level positions may be eligible for sign-on and relocation bonuses.

Operations Manager

• Performs retrospective (post –discharge/ post-service) medical necessity reviews to determine appellate potential of clinical disputes/denials or those eligible for clinical review.
• Demonstrates proficiency in use of medical necessity criteria sets, currently InterQual® or other key factors or systems as evidenced by Inter-rater reliability studies and other QA audits. Constructs and documents a succinct and fact based clinical case to support appeal utilizing appropriate module of InterQual® criteria (Acute, Procedures, etc). If clinical review does not meet IQ criteria, other pertinent clinical facts are utilized to support the appeal. Pertinent clinical facts include, but are not limited to, documentation preventing a safe transfer/discharge or documentation of medical necessary services denied for no authorization.
• Demonstrates ability to critically think and follow documented processes for supporting the clinical appellate process.
• Adheres to the department standards for productivity and quality goals. Ensuring accounts assigned are worked in a timely manner based on the payor guidelines.
• Demonstrates proficiency in utilization of electronic tools including but not limited to ACE, nThrive, eCARE, Authorization log, InterQual®, VI, HPF, as well as competency in Microsoft Office.
• Demonstrates basic patient accounting knowledge i.e. UB92/UB04 and EOB components, adjustments, credits, debits, balance due, patient liability, denials management, etc.
• Additional responsibilities:
• Serves as a resource to non-clinical personnel.
• Provides CRC leadership with sound solutions related to process improvement
• Assist in development of policy and procedures as business needs dictate.
• Assists Law Department with any medical necessity reviews as capacity allows up to and including attending mediation hearings, other litigation forums, etc.

Nurse Quality Analyst

• Review call statistics, staffing models and reporting to assist with capacity planning, optimization, and performance management. Expected to make recommendations to the Director regarding necessary adjustments to procedures or staffing to ensure excellent customer service and operational objectives are met or exceeded.
• Communicates with internal client management team and external clients; receiving and documenting any concerns or questions in regard to departmental procedures and quality of service.
• Exercise leadership and motivate supervisors and team members to incorporate vision, strategic planning, and elements of quality management into the full range of the department's activities; encouraging creative thinking and innovation; influencing others toward a spirit of service; implementing new or cutting-edge programs/processes
• Responsible for assisting the supervisors with meeting department service level requirements. Lead the continued improvement of all quality and training programs for department. Manage workflow, project calendar, and timelines
• Work closely with clients, emerging team members and management through side-by-side review and coaching. Review, research, and respond to Issues Logged, emails, and or phone calls by facility representatives, on a daily basis as the Subject matter expert. Respond in a timely manner in accordance with established service deliverables
• Oversees departmental policies, practices, procedures, and work rules according to approved department and hospital policies and assists in developing and implementing new policies according to hospital and corporate guidelines.
• Maintains and coordinates daily team huddles to sustain a culture of collaboration, staff appreciation and ongoing communication, ensuring supervisors and representatives are set up for success.

Patient Engagement Manager

• 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.
• 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
• 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.

Patient Account Representative

IT Support

• The SPEC, PHYS SVC EDIT is responsible for the processing and monitoring of claim edits.
• The SPEC, PHYS SVC EDIT ensures claims are correct by analyzing TES edits, claim form requirements and rejections.
• ESSENTIAL DUTIES AND RESPONSIBILITIES
• Include the following. Others may be assigned.
• Resolve daily clearinghouse edits
• Resolve daily host system claim form edits
• Resolve edits within EPIC Edit WQ’s, Retro, etc
• Resolve Statement/Return Mail address edits
• Print Medical Records/Documentation
• Contact various insurance carriers to resolve edits
• Responsible for reviewing accounts, verifying eligibility, updating registration, rebill activities and leaving detailed account notes
• Meets or Exceeds department Productivity standard 20 invoices/hour depending on client worked
• Meets or Exceeds Quality Assurance standard of 95% or higher
• Communicate with clients via email
• Train new hires
• Other duties may be 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.
• Good problem solving and analytical skills
• Good communication skills
• Good organizational skills and priority planning
• Ability to perform essential job functions with moderate degree of independence, flexibility, and creative problem-solving techniques
• Attentive listening skills
• Good attention to detail
• Ability to Multi-task
• 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 preferred to perform the job.
• High School diploma or equivalency required
• 1-4yrs IDX/EPIC/Next Gen experience
• 1-4yrs Collection or Medical insurance billing experience
• Moderate Excel knowledge
• Ability to work independently and multi-task various assignments
• Good written and oral communication skills
• Good problems solving and analytical skills
• 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 work additional hours as needed
• Ability to work in a fast-paced environment
• 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.
• Business office environment

Physician Services Edit Specialist II

• Conducts data quality audits of inpatient admissions and outpatient encounters to validate coding accuracy against official guidelines; supports payment methodology.
• Consulting: Consults facility leaders and staff on best practices, methodology, and tools for accurately coding.
• Chart Analysis IP, OP Coding Data auditing and validation: Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures; adheres to Standards of Ethical Coding (AHIMA) and reviews discharge disposition.
• IP, OP Coding: Reviews medical records for accurate ICD-9-CM codes for diagnoses and procedures.
• Coding: Uses discretion and specialized coding training to accurately assign ICD-9, CPT-4 codes to patient records.
• Abstracting: Reviews medical records to determine accurate required abstracting elements including discharge disposition.
• Coding Quality: Demonstrates accuracy and consistency in principal and secondary diagnoses and procedures, including MCC/CC, and abstracting elements per SOW.
• CDI: Identifies and communicates documentation improvement opportunities and coding issues to appropriate personnel for follow-up and resolution.
• Professional Development: Stays current with AHA Official Coding and Reporting Guidelines, CMS and other directives; attends seminars and quarterly updates.

Coding Quality Auditor

• Gather, interpret, and translate customer needs and translate business problems into requirements that facilitate application development
• Analyze and assess data and product performance to identify issues and ensure appropriate prioritization and compliance with service level agreements
• Build reporting solutions and develop/enhance existing scorecards, dashboards and other key reports that arto be utilized by management to monitor performance and communicate performance to the client.
• Develop and maintain standards to measure the effectiveness of all aspects of the revenue cycle, including statistical data for monthly reports (denial reports, late charge reports, etc.).
• Integrate and analyze data from multiple data sources, determine root cause; summarize and prepare monthly materials for discussions with client and finance teams. Audit and analyze data to verify quality and data integrity. Provide feedback regarding issues and/or anomalies found during analysis to ensure proper communication both internally and externally.
• Serve as resource for special projects and priority assignments as needs are identified during the analysis process.
• Prioritize and manage multiple tasks to meet deadlines

Operations Performance Analyst

• 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.