Community Health Systems Claims Resolution Rep 3 in Nashville, Tennessee


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 PPS 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 PPS AR Analysts to prevent reoccurrence of these issues.

Identifies researches and rectifies claimmapping issues in Athena Collector.

Identifies researches and rectifies claim inMGRHOLDS 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 demeanorin 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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Job: Business Office Support

Organization: PPSI

Location: TN-Nashville

Requisition ID: 1837622

This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment.