GOVERNMENT OPERATIONS SPECIALIST

JOB SUMMARY

Serves as the primary point of contact for account specific billing issues for Centers of Excellence and the facility for complex government accounts. Provides expert guidance to Clients in regard to Government audit correspondence, reporting and data. Foster strong professional working relationships with other departments in the company, delivers information to external customers/clients (i.e., QIC, MAC, RAC, .EHR, etc.) to aid in the implementation of cross-functional cooperation and improvement of interdepartmental processes.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Conducts high-level problem solving with a focus on compliance and Revenue Cycle.


• Validate denial reasons and ensures coding in DCM is accurate and reflects the denial reasons. Coordinate with the Clinical Resource Center (CRC) for clinical consultations and National Coding Center (NCC) for account referrals when necessary as well as the facility Directors of Revenue and HIM.


• Complete medical records requests for audits or ensure proper delegation to external clients within specific lines of business for medical record retrieval and timely submission to payer as well as ensuring the follow-up process for audit results are being acted on in a timely matter.


• Prepare, present and track any Government Audit Services projects and reporting its status to clients and Leadership as well as documenting cases clearly and communicating effectively, orally and in written form with insurance agencies and CMS with regard to audit and appeal activities.


• Addresses systemic root causes of chronically recurring problems.


• Serves as the primary point of contact between the Centers of Excellence and the facility for account specific billing issues.


• Provides expert guidance to Clients in regard to Government audit correspondence, reporting and data. Foster strong professional working relationships with other departments in the company, delivers information to external customers/clients (i.e., QIC, MAC, RAC, .EHR, etc.) to aid in the implementation of cross-functional cooperation and improvement of interdepartmental processes.


• Provides operational guidance regarding revenue cycle policies and procedures.


• Identifies system and operational issues and addresses with Operations Leadership Team and Revenue Cycle Director.


• Utilizes high level problem solving, with a focus on compliance, in an effort to seek out and identify system and operational issues and provide creative solutions to the Government Audit Leadership and business partners.


• Functions as next level of issue escalation for Onsite support and depts.

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.

• Knowledge of Medical Record documentation


• Knowledge of writing disputes( appeals 1^st ,2^nd 3^rd level)


• Ability to work independently and exercise good judgement and independence to problem solve.


• Advanced knowledge of Excel and Proficient Advanced knowledge of all Microsoft Office Products


• Ability to multiple task, meet deadlines and lead team to adapt to change


• Ability to speak professionally to help drive resolution for resolving complex claims


• Proficient Advanced knowledge of Microsoft Office


• Ability to train coach and mentor staff


• Ability to travel if needed to train staff


• Strong Leadership and organizational skills


• Strong Knowledge of coding terminology such as HCPCS, Diagnosis & ICD 10 , DRG & Revenue Codes


• 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


• Bachelor’s Degree Business or Healthcare


• 3 – Years’ experience in Billing and AR Follow-Up (Can be a combination of both).


• 3-4 Years of Medicare knowledge experience in resolving Medicare claims (Clear knowledge of UB04 billing requirements for Medicare)


• 1 year customer service 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.

• Must be able to work in sitting position, use computer and answer telephone


• Ability to travel


• Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments

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 Work Environment


• Hospital Work 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!

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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.