TridentCare

Accounts Receivable

• Preparing and submitting claims for accounts to ensure timely reimbursement
• Investigating and processing refunds when warranted
• Preparing, editing and submitting account billing in accordance with payer guidelines
• Verifying patient’s insurance eligibility
• Submitting all required documentation with claim
• Updating patient demographics changes and performing required rebilling
• Researching accounts and documenting follow up appropriately
• Resolving account discrepancies and preparing adjustments and refunds for approvals as necessary
• Maintaining accurate and complete records concerning billing activity on all accounts
• Keeping supervisor advised of area or compliance issues which may lead to untimely or inaccurate completion of invoice or claim submission

Accounts Receivable Representative – 3rd Party Non-Governmental Payers

Billing Specialist

• Prepare, edit and submit account billing in accordance with client contract or payer guidelines.
• Ensure all invoices are submitted accurately and timely per P&P (Policy & Procedure).
• Work biller related errors in error work queue.
• Submit system contract/fee schedule changes when required.
• Submit all required documentation with invoice.
• Updates facility census changes and performs required rebilling.
• Requests necessary documentation when missing from client, physician or patient.
• Access clients files if necessary to verify insurance.
• Address problems as they occur.
• Keep supervisor advised of area or compliance issues which may lead to untimely inaccurate completion of invoice or claim.
• Complete all reports according to assigned deadlines.
• Verify and update insurance information every 30 calendar days.

Billing Representative

Customer Support

• Responsible for receiving and processing customer orders by telephone
• Ensure all customer requests are handled in a prompt, efficient, courteous, and professional manner
• Process all customer orders in accordance with the established company standards and procedures
• Make a concerted effort to listen to the customer’s needs and provide them with a positive experience
• Cross trained in the other positions within the department
• Handle an average of 110 customer interactions per eight (8) hour shift after 4 months in the position
• Provide prompt, accurate and courteous responses to customers
• Solve routine and complex problems
• Document activity to the DDF system
• Consistently check appropriate DDF screen for report results to call back to customer
• Display the ability to enter orders manually via fax process
• Display the ability to operate the phone system effectively
• Adhere to work schedule
• Other duties as assigned

Customer Service Representative

• Contact doctors via email and phone to read cases as needed.
• Notification to customers when cases are delayed with estimated completion time if known.
• Monitors the delivery of x-ray reports delivered via fax.
• Relays verbal x-ray results on critical findings to the ordering facility and/or physician.
• Documents, research, and resolves customer issues using the computer system.
• Upholds client and patient confidentiality at all times.
• Maintains training manuals and disseminates new policies or procedures or changes to same.
• Maintains regular consistent attendance, punctuality, and personal appearance.
• Adheres to all company regulations as stated in the company handbook.
• Create and manage the Support Specialists staffing schedules.
• Approve and schedule PTO and Vacation requests from employees.
• Train and supervise Support Specialists and assist with reviews.
• Rotate schedule as needed to work with every shift to observe performance and train staff.
• Answer general questions and assist other staff throughout the shift.
• Provide assistance off hours by phone as needed.
• Communicate with the IT department regarding the status of the systems and development and testing of new programming.
• Other duties as assigned.

Radiology Support Specialist

• Prepare, submit and follow up on Healthcare claims
• Verify patient’s insurance eligibility
• Resolve account discrepancies

Revenue Cycle Accounts Receivable Representative

QA Engineer

• Facility Contracting & Quality Assurance (QA) Services analyst responsible for review and auditing of facility contracts.
• Primary point of contact for contractual billing questions and/or concerns from internal/external customers.
• Audits the correctness of all facility contracts and FDS entered by AMS.
• Works with Sales Reps/RGM’s to obtain all outstanding contracts.
• Responsible for assisting with the transition of the acquisition process, to include review of contracts, invoicing pricing and auditing the accuracy of information in appropriate systems.
• Performs monthly billing audits to ensure compliance with company policies/procedures, government and contractual requirements.
• Keeps the Manager of Facility Contracting & Quality Assurance advised of concerns and compliance issues.
• Timely response to internal and external customers via email/voicemail.

Quality Assurance Analyst – RCM

Medical writer

• Completes patient medical record reviews to support compliance audits, organizational risk assessments, and ongoing monitoring activities.
• Responsible for reviewing and determining that supporting documentation demonstrates performance of medically necessary services.
• Supports random and focused pre-payment and post payment audits in the review of patient medical records.
• Completes medical record reviews in a timely manner.
• Assists to ensure all possible efforts are made to obtain appropriate internal and external patient medical record documentation to support the services provided and billed.
• Supports the tracking of medical documentation received, outbound requests, and ensures all necessary information is obtained (where they exist).
• Follows related policies and procedures and escalates where appropriate.
• Assists in medical review related customer chart documentation trend analysis for outreach training and education opportunities.
• Ensures all reasonable efforts are made to obtain appropriate external medical record documentation to support the services in question.
• Ensures medical record documentation received is recorded appropriately and aids in the management of outbound documentation requests.
• Assists Senior Clinical Specialist with other areas of responsibility as requested.

Clinical Documentation Support Specialist

Business Analyst

• This role works closely with various business stakeholders, cross-functional teams including Sales, Customer Service, Finance, IT and the Warehouse to support daily operations, identify areas for improvement, and help implement changes that drive business value.
• Gathers business requirements, conducts needs assessments, and develops functional specifications to ensure that developed information technology solutions support business objectives.
• Serves as a liaison between development teams and the internal/external customer or end user.
• Follows an established requirements gathering process to identify requirements.
• Communicates requirements to the development teams through the use of specifications, statements of work, project plans, or other forms of documentation.
• Coordinates with developers, quality assurance teams, and users to test processes and ensure functionality and user acceptance.
• May develop user documentation or training materials Create BRD, FRD and other business analysis documents.
• Translate business needs into functional specifications for system enhancements or workflow changes.
• Document current-state and future-state process maps, data flows, and system interactions.
• Develop and maintain documentation for business processes, system configurations, and training materials.
• Troubleshoot user issues and escalate as needed to senior analysts or development teams.
• Assist with project planning, execution, and closure of organizational initiatives.
• Collaborate with cross-functional teams to ensure alignment and effective implementation of processes.
• Conduct data analysis to identify trends, patterns, and areas for improvement in performance.
• Ensure compliance with relevant regulations and industry standards for processes, especially within the healthcare industry.
• Provide hands-on support for business systems, with a focus on order processing and customer fulfillment.
• Assist in configuration updates and related operational tasks.
• Analyze current workflows and suggest opportunities to improve accuracy, speed, and customer experience.
• Support business teams during system testing and validation phases.
• Assist with building and maintaining operational reports and dashboards.
• Analyze transactional data to identify trends or gaps impacting O2C performance.
• Participate in system enhancements, including requirement validation, UAT support, and go-live monitoring.
• Work with third-party vendors and internal developers to support integrations with other systems.
• Create user guides, process documentation, and training materials.
• Help train end users with new functionality or system updates.

Data Entry

• This position is responsible for receiving and processing customer orders by telephone and ensuring all customer requests are handled in a prompt, efficient, courteous and professional manner.
• The CSR will process all customer orders in accordance with the established company standards and procedures.
• Be able to handle an average 110 customer interactions per eight (8) hour shift after 4 months in the position.
• This includes incoming and outgoing calls.
• Provide prompt, accurate and courteous responses to customers
• Solve routine and complex problems (Contact supervisor immediately for problems unable to solve)
• Answer incoming customer service orders as soon as possible
• Display active listening and superior customer service skills for both external & internal customers.
• Document activity to the DDF system
• Consistently check appropriate DDF screen for report results to call back to customer
• Display the ability to enter orders manually via our fax process
• Display the ability to operate the phone system effectively
• Adhere to work schedule
• Other duties as assigned