Claims Resolution

Community Health Systems, Inc. is one of the nation’s leading operators of general acute care hospitals. The organization’s affiliates own, operate or lease 200 hospitals in 29 states with approximately 30,400 licensed beds. Affiliated hospitals are dedicated to providing quality healthcare for local residents and contribute to the economic development of their communities.

**Summary:** Serves as subject matter expert in all billing and revenue cycle transactions for assigned clinic locations/table spaces. **Essential Duties and Responsibilities:** Include the following. Other duties may be assigned. * Reviews workflow dashboards and AR aging reports with the PPSI AR Analysts to identify trends in Key Indicators that impact the clinics financial performance * Identifies researches and rectifies any circumstances affecting delayed submission of insurance accounts or payment of accounts; Provides feedback / education to PPSI AR Analysts to prevent reoccurrence of these issues. * Identifies researches and rectifies claim mapping issues in Athena Collector. * Identifies researches and rectifies claim in MGRHOLDS that involve provider numbers, or taxonomy issues. * NPI Rep coordinates with Provider Enrollment to keep appropriate staff up to date on credentialing issues and status. * NPI Rep manages all enrollments with Rail Road Medicare. * Ability to conduct “root cause” analysis as a result of trends within the key performance indicators * Maintains current knowledge base of all Federal and state billing regulations and guidelines * Demonstrates a positive and professional demeanor in all interactions with clinic employees, corporate personnel, and other associates * Identifies opportunities for improvement within the clinic operations as well as CBO work flow processes * Prepares and reviews reports/ documents with appropriate staff as required * Demonstrates ability to identify issues outside work flow process and escalates them when necessary **Supervisory Responsibilities:** * This job has no supervisory responsibilities **Competencies:** To perform the job successfully, an individual will demonstrate the following competencies: * Analytical - Collects and researches data; Uses intuition and experience to compliment data. Possesses a solid attention to detail to ensure accuracy of information * Customer Service - Responds promptly to customer needs in a professional manner * Interpersonal Skills - Maintains confidentiality of all patient information and company documents * Oral Communication – Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions. * Written Communication – Writes clearly and informatively; Edits work for spelling and grammar; Presents numerical data effectively; Able to read and interpret written information * Professionalism - Approaches others in a tactful manner; Treats others with respect and consideration regardless of their status or position. Maintains positive business relationships. * Quality - Demonstrates accuracy and thoroughness * Quantity - Meets performance and / or productivity standards * Adaptability - Adapts to changes in the work environment * Attendance/Punctuality - Is consistently at work and on time

**Qualifications:** * 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. **Education and/or Experience Preferred:** * High school diploma or general education degree (GED); 2 years of revenue cycle management with a general knowledge of ICD9 and CPT coding; or equivalent combination of education and experience. * Provider Enrollment/Credentialing knowledge and Physician Billing experience preferred. **Language Skills:** * Ability to read and comprehend simple instructions, short correspondence, and memos. * Ability to write simple correspondence. * Ability to effectively present information in one-on-one and small group situations. **Reasoning Ability:** * Ability to apply common sense understanding to carry out detailed written or oral instructions. * Ability to deal with problems involving a few concrete variables in standardized situations. **Computer Skills:** * To perform this job successfully, an individual must have strong keyboarding skills, working knowledge of Microsoft Office (Word / Excel) as well as practice management systems. **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. While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to reach with hands and arms and stoop, kneel, crouch, or crawl. * The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision and ability to adjust focus. * 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.