Billing Specialist for Carondelet Case Resolution Team

Tenet Healthcare

  • Tucson, AZ
  • Permanent
  • Full-time
  • 14 days ago
Job Category: Finance/AccountingDegree Level: High School Diploma/GED (±11 years)Job Description:REMOTE (must reside in Tucson)General Summary: Responsible for escalated support for call center agents for situations requiring more research or insurance follow-up activities. Works cases from a worklist generated by agents. Monitors for trends in provider or market-level issues to report to market leadership to prevent further issues.Responsibilities:Essential Job Responsibilities: * Resolve cases for assigned markets, becoming a subject matter expert on issues unique to the payers in the market. Mentor and provide constructive feedback to call center agents in ways to more effectively handle situations that led to the case in the future.
  • Compile examples of emerging issues from denials, staff actions, or patient dissatisfaction.
  • Participate in billing meetings at the market and national level as needed.
  • Review and respond to billing questions from call center staff on a timely basis and follow up as needed.
  • Research payer and MAC websites for claim status or denial information, proactively educating fellow case resolver staff or call center staff.
  • Review claims for accuracy.
  • Assess possibility of CPT, modifier, or diagnosis issues per payer and refer case to through coding review process when required.
  • Explain to agent or patient what was discussed during visit using available resources
  • Review held cases for resolution.
  • Review any coding corrections, adjustments, or credentialing issues during monthly meeting and escalate held cases over 10 days or sooner as needed.
Qualifications:Education: High school diploma or equivalent is required.Experience: 3+ years of experience with physician office billing in a corporation or large multi-specialty physician group practice.Working knowledge of CPT-4, HCPCS, ICD-10, and third party payer rules is required. Understanding of payer explanation of benefits forms.Experience in problem-solving. Exercising initiative, judgment, and discretion a must.Must have excellent written, verbal and interpersonal skills as well as the ability to present information and communicate effectively to a wide variety of people within the organization as well as payer representatives outside the organization.Detail oriented with the ability to identify and research payer documentation and claims to identify areas for process improvement.Ability to organize data and present findings using Microsoft Excel and/or PowerPoint.Work in a fast paced environment sitting for long periods of time.About Us: Who We AreWe are a community built on care. Our caregivers and supporting staff extend compassion to those in need, helping to improve the health and well-being of those we serve, and provide comfort and healing. Your community is our community.Our StoryWe started out as a small operation in California. In May 1969, we acquired four hospitals, some additional care facilities and real estate for the future development of hospitals. Over the years, we've grown tremendously in size, scope and capability, building a home in new markets over time, and curating those homes to provide a compassionate environment for those entrusting us with their care.We have a rich history at Tenet. There are so many stories of compassionate care; so many "firsts" in terms of medical innovation; so many examples of enhancing healthcare delivery and shaping a business that is truly centered around patients and community need. Tenet and our predecessors have enabled us to touch many different elements of healthcare and make a difference in the lives of others.Our Impact TodayToday, we are leading health system and services platform that continues to evolve in lockstep with community need. Tenet's operations include three businesses - our hospitals and physicians, USPI and Conifer Health Solutions.Our impact spreads far and deep with 65 hospitals and approximately 510 outpatient centers and additional sites of care. We are differentiated by our top notch medical specialists and service lines that are tailored within each community we serve. The work Conifer is doing will help provide the foundation for better health for clients across the country, through the delivery of healthcare-focused revenue cycle management and value-based care solutions.Together as an enterprise, we work to save lives and can accept nothing less than excellence from ourselves in service of our patients and their families, every day.About the Team: Careers at TenetAt Tenet Healthcare, the heart of what we do centers on caring with compassion, which ultimately creates a bond between our caregivers and patients. Everyone contributes to these moments, whether providing care directly or supporting those who do.As an organization, we provide employees with resources, tools and support to serve our patients and customers in the best way possible. We also take care of one another, helping team members further develop their career pathways and maximize their potential.

Tenet Healthcare