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 Quality Assurance Coordinator is responsible for the completion of manual and system-driven inspections aimed to measure Quality Assurance across critical business processes. The Quality Assurance Coordinator has responsibility of preparing reports to communicate QA results and findings to Management Team and process owners across the organization, driving accountability and ongoing improvement of QA metrics. This individual must understand policies and procedures and utilize them for daily Quality Assurance duties. The selected candidate will be a business professional who is motivated and enthusiastic with an exceptional eye for detail and process improvement.
Complete quality assurance inspections as required, ensuring standardization and compliance with established policies and procedures and applicable regulations.
Identify, research and document process improvement opportunities. Then collaborate with internal and external business partners (Operations, Compliance, Facilities, Payers) to drive accountability and process improvements
Prepare and review data and QA reporting with key stakeholders.
Prepare monthly plan with daily targets to meet established inspection volumes, accuracy levels and critical deadlines.
Provide input for policies and procedures updates as required.
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 review and audit recorded work effort on claims and phone calls to review items such as inaccurate payment postings, contractual adjustments, reclassification of accounts, denied claims, debits, credits and appeals.
Will review critical business processes, primarily billing, collections, dispute and denial management for different lines of business (Medicare, Medicaid, Managed Care, etc).
Ability to work independently to meet objectives in a repetitive auditing environment.
Ability to identify problems, gather and analyze information skillfully and provide recommendations for process improvements.
Detailed oriented. Strong ability to detect errors and discrepancies.
Excellent written and verbal communication skills.
Demonstrated ability to build strong working relationships with key internal and external stakeholders (Centralized Operations, Compliance, Facilities).
Change agent: Ability to speak up and challenge the status quo, identify improvement opportunities and carry them thru execution.
Ability to manage time to meet production requirements by establishing priorities.
Ability to be cross-trained to review additional lines of business.
Works with supervisors to identify department training needs for system education, industry updates and changes in collection processes and protocols.
Works with Supervisors to ensure that employee productivity and quality meets standards
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
4 year college degree is required. Degree in Healthcare Administration, Business or related field is preferred.
1-2 years of healthcare billing experience Centralized Operations Billing, Cash Collections, Denials, Disputes, Follow-up, and Appeals.
Extensive knowledge on critical business processes, primarily Billing, Collections, Dispute and Denial Management for different line of businesses (Medicare, Medicaid, Managed Care, etc).
Medical billing and claims experience with an understanding of healthcare reimbursement process.
Working knowledge of critical systems such as ACE, VI Web, On Demand, PBAR, MedAssets, Epremis and workflow.
Strong computer skills, and intermediate skill level in Microsoft Office applications (Word and Excel) is required.
Medical billing and claims experience with an understanding of healthcare reimbursement processes.
Working knowledge of Electronic billing, Hardcopy billing, UB-04s, ICD-9 codes, and CPT codes.
Trained in HIPAA guidelines.
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.
Includes ability to type, sit for long periods of time, view claims on a computer, and listen to phone calls through headphones.
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
Moderate office noise
Approximately 0% travel may be required
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.