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Government Operations Analyst

2 months ago

Birmingham, Alabama, United States Conifer Revenue Cycle Solutions Full time

JOB SUMMARY


Acts as the primary liaison for account-specific billing inquiries related to complex government accounts within the Centers of Excellence and the facility.

Offers expert advice to clients concerning government audit communications, reporting, and data management.

Builds and maintains strong professional relationships with various departments within the organization, providing essential information to external stakeholders (such as QIC, MAC, RAC, EHR, etc.) to facilitate cross-departmental collaboration and enhance interdepartmental processes.


ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Other duties may be assigned.

Engages in high-level problem resolution with an emphasis on compliance and revenue cycle management.

Confirms denial reasons and ensures that coding in DCM is precise and accurately reflects those reasons.


Collaborates with the Clinical Resource Center (CRC) for clinical consultations and the National Coding Center (NCC) for account referrals when necessary, as well as with the facility Directors of Revenue and Health Information Management (HIM).


Handles medical records requests for audits or ensures proper delegation to external clients for medical record retrieval and timely submission to payers, while also overseeing the follow-up process for audit results.


Prepares, presents, and monitors any Government Audit Services projects, reporting their status to clients and leadership, while documenting cases clearly and communicating effectively, both orally and in writing, with insurance agencies and CMS regarding audit and appeal activities.

Addresses systemic root causes of recurring issues.


Serves as the primary contact between the Centers of Excellence and the facility for account-specific billing matters.

Provides expert advice to clients concerning government audit communications, reporting, and data management.

Builds and maintains strong professional relationships with various departments within the organization, providing essential information to external stakeholders (such as QIC, MAC, RAC, EHR, etc.) to facilitate cross-departmental collaboration and enhance interdepartmental processes.

Offers operational guidance on revenue cycle policies and procedures.

Identifies system and operational challenges and addresses them with the Operations Leadership Team and Revenue Cycle Director.


Utilizes advanced problem-solving skills, focusing on compliance, to identify system and operational challenges and provide innovative solutions to the Government Audit Leadership and business partners.

Acts as the next level of issue escalation for onsite support and departments.

KNOWLEDGE, SKILLS, ABILITIES

To perform this role successfully, an individual must be able to fulfill 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 essential functions.

Understanding of medical record documentation

Experience in writing disputes (appeals)

Ability to work independently and exercise sound judgment and independence in problem-solving.

Advanced proficiency in Excel and all Microsoft Office products

Capability to multitask, meet deadlines, and lead teams in adapting to change

Ability to communicate professionally to facilitate resolution of complex claims

Proficient knowledge of Microsoft Office

Ability to train, coach, and mentor staff

Willingness to travel if necessary to train staff

Strong leadership and organizational skills

Thorough understanding 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 in Business or Healthcare

3 years of experience in Billing and Accounts Receivable Follow-Up (can be a combination of both).

3-4 years of Medicare knowledge experience in resolving Medicare claims (clear understanding of UB04 billing requirements for Medicare)

1 year of 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 a seated position, use a computer, and answer telephone calls

Ability to travel

Includes the ability to navigate 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 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 assist our clients in enhancing their financial and clinical performance, serving their communities, and succeeding in the business of healthcare.

Conifer Health aids organizations in transitioning from volume to value-based care, improving the consumer and patient healthcare experience, and enhancing quality, cost, and access to healthcare.

Are you ready to be part of our solutions? Welcome to the company that provides you with the resources and incentives to redefine healthcare services, along with a competitive benefits package and leadership to advance your career.
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.