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!
The Revenue Cycle Compliance Specialist will provide support to the Conifer Revenue Cycle Compliance leaders and assist in the implementation and monitoring of internal controls and provide support for the execution of the revenue cycle compliance program.
Under the direction of the Revenue Cycle Compliance leaders, the Revenue Cycle Compliance Specialist (RCCS) will prepare and/or conduct periodic and billing compliance related audits, reviews, and preliminary investigations into potential areas of non-compliance with appropriate laws, regulations, billing compliance policies, and federal guidelines.
General activities associated with the position include assisting in: (1) auditing and monitoring activities, (2) conducting/documenting preliminary billing compliance investigations, (3) assist in performing of billing compliance audits, (4) Assist in monitoring compliance program elements, and (5) assist in the development of revenue cycle billing compliance procedures and education for Conifer, Tenet, TPR, and USPI team members.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
At the direction of the Revenue Cycle Compliance leaders, facilitate timely completion of regulatory, operational and billing compliance review, focused audits, and Ad-hoc audits.
Supports the effective operation of the Revenue Cycle Billing Compliance Program by providing support to the Revenue Cycle Compliance team in assessing risk, developing and implementing compliance work plan initiatives, and providing subject-matter expertise support when needed.
Provides subject-matter expertise support in revenue cycle billing and coding compliance inquiries and investigations and to operational partners.
Track, analyze and communicate the results of billing audits to leaders. assist in developing, process improvements based on audit results.
Assist in activities related to the implementation of new regulations or policies, including any necessary revisions to the existing policies, and procedures.
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.
Ability to work independently with little supervision and seek guidance as needed to clarify assignments or request for information
In depth knowledge of billing compliance practices. Knowledge of ASC coding, hospital coding, provider coding and billing practices.
Understanding of CMS billing regulations, CPT/ICD10 coding and documentation guidelines and documentation requirements.
Ability to establish and maintain effective working relationships with clients in relation to appropriate documentation practices and compliance.
Excellent communication, customer service and time-management skills
Possess basic business skills, an understanding of general compliance operations and department goals in the healthcare environment.
Proficient with various desktop applications such as Microsoft Excel, Word, PowerPoint, Visio.
Intermediate knowledge of relational database management systems
Must be a team player - Always willing to help in whatever way possible and go the extra mile to get the job done.
Intuitive and skilled at problem solving in anticipation of customer request
Have the ability to make logical correlations between data points to determine if analysis is accurate
Detail oriented, meticulous and accurate in completing tasks on time.
Thorough knowledge of federal and state healthcare laws and regulations, including, but not limited to, government and commercial payers as it relates to reimbursement, risk areas such as overpayments/credit balances, conflicts of interest, use of Advance Beneficiary Notices (ABNs), teaching physicians guidelines, incident-to services, HIPAA, timely filing limitations and others
Ability to provide clear and concise regulatory billing and coding compliance guidance to business partners
Experience investigating and assist in resolving physician, ASC and hospital coding and billing inquiries.
Ability to analyze, summarize, and develop reporting for coding and billing compliance risk areas.
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
Associates or Bachelorï¿½s degree in or related field from an accredited four-year college or university, or equivalent relevant experience
Minimum Five years of related revenue cycle work experience in the healthcare industry.
Include minimum certification required to perform the job.
Certification in Healthcare Compliance (CHC) preferred
Possess at least one of the following certifications: AHIMA- RHIT, CCS CCS-P; AAPC-CPC, COC, CPMA; and/or clinical experience as an RN or LPN with the expectation of earning a certification within one year.
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 lift and/or move up to 25 pounds
Specific vision abilities required by this job include close vision.
Ability to travel, approximately up to 10%
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
Remote Office Work Environment
Job: Conifer Health Solutions
Primary Location: Frisco, Texas
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��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.
Internal Number: 1905037585
About Conifer Health Solutions
“Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans.