Conifer Revenue Cycle Solutions - Birmingham, AL
posted 4 months ago
The Government Operations Specialist serves as the primary point of contact for account-specific billing issues related to complex government accounts within the Centers of Excellence and the facility. This role is crucial in providing expert guidance to clients regarding government audit correspondence, reporting, and data management. The specialist is responsible for fostering strong professional relationships with various departments within the company and delivering essential information to external customers and clients, such as QIC, MAC, RAC, and EHR, to enhance cross-functional cooperation and improve interdepartmental processes. In this position, the specialist conducts high-level problem-solving with a focus on compliance and revenue cycle management. They validate denial reasons and ensure that coding in the Denial Case Management (DCM) system is accurate and reflective of those reasons. Coordination with the Clinical Resource Center (CRC) for clinical consultations and the National Coding Center (NCC) for account referrals is also a key responsibility. The specialist is tasked with completing medical records requests for audits, ensuring proper delegation to external clients for medical record retrieval, and timely submission to payers, while also following up on audit results. The role involves preparing, presenting, and tracking Government Audit Services projects, reporting their status to clients and leadership, and documenting cases clearly. The specialist addresses systemic root causes of recurring problems and provides operational guidance regarding revenue cycle policies and procedures. They identify system and operational issues, addressing them with the Operations Leadership Team and Revenue Cycle Director, and utilize high-level problem-solving skills to seek out and identify issues while providing creative solutions to the Government Audit Leadership and business partners. Additionally, the specialist functions as the next level of issue escalation for onsite support and departments.