Denial Management Representative - Remote

Job Summary

The Patient Account Representative is responsible for working accounts to ensure they are resolved in a timely manner. This candidate should have a solid understanding of the Revenue Cycle as it relates to the entire life of a patient account from creation to payment. Representative will need to effectively follow-up on claim submission, remittance review for insurance collections, create and pursue disputed balances from both government and non-government entities.

Basic knowledge of Commercial, Managed Care, Medicare and Medicaid insurance is preferable. An effective revenue cycle process is achieved with working as part of a dynamic team and the ability to adapt and grow in an environment where work assignments may change frequently while resolving accounts with minimal assistance.

• Perform duties as assigned in a professional demeanor, which includes interacting with insurance plans, patients, physicians, attorneys and team members as needed.
• Basic computer skills to navigate through the various system applications provided for additional resources in determining account actions.
• Access payer websites and discern pertinent data to resolve accounts.
• Utilize all available job aids provided for appropriateness in Patient Accounting processes.
• Document clear and concise notes in the patient accounting system regarding claim status and any actions taken on an account.
• Maintain department daily productivity goals in completing a set number of accounts while also meeting quality standards as determined by leadership.
• Identify and communicate any issues including system access, payor behavior, account work‑flow inconsistencies or any other insurance collection opportunities.
• Provide support for team members that may be absent or backlogged.

• Research each account using company patient accounting applications and internet resources that are made available. Conduct appropriate account activity on uncollected account balances with contacting third‑party payors and/or patients via phone, e‑mail, or online. Problem‑solve issues and create resolution that will bring in revenue eliminating re‑work. Update plan IDs, adjust patient or payor demographic/insurance information, note account in detail, identify payor issues and trends and solve re‑coup issues.
  
  Request additional information from patients, medical records, and other needed documentation upon request from payors. Review contracts and identify billing or coding issues and request re‑bills, secondary billing, or corrected bills as needed. Take appropriate action to bring about account resolution timely or open a dispute record to have the account further researched and substantiated for continued collection. Maintain desk inventory to remain current without backlog while achieving productivity and quality standards.
• Perform special projects and other duties as needed. Assist with special projects as assigned, document findings, and communicate results.
• Recognize potential delays and trends with payors such as corrective actions and respond to avoid A/R aging. Escalate payment delays/problem‑aged account timely to Supervisor.
• Participate and attend meetings, training seminars and in‑services to develop job knowledge.
• Respond timely to emails and telephone messages as appropriate.
• Ensure compliance with State and Federal laws and regulations for Managed Care and other third‑party payors.

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.

• Thorough understanding of the revenue cycle process, from patient access (authorization, admissions) through Patient Financial Services (billing, insurance appeals, collections) procedures and policies.
• Intermediate skill in Microsoft Office (Word, Excel).
• Ability to learn hospital systems – ACE, VI Web, IMaCS, OnDemand quickly and…