Government Operations Specialist

Conifer Revenue Cycle Solutions - Birmingham, AL

Full-time - Mid Level

Birmingham, AL

101-250 employees

Insurance Carriers and Related Activities

About the position

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.

Responsibilities

• Serve as the primary point of contact for account-specific billing issues for complex government accounts.
• Provide expert guidance to clients regarding government audit correspondence, reporting, and data.
• Foster strong professional working relationships with other departments and deliver information to external customers/clients.
• Conduct high-level problem solving with a focus on compliance and revenue cycle management.
• Validate denial reasons and ensure accurate coding in the Denial Case Management (DCM) system.
• Coordinate with the Clinical Resource Center (CRC) for clinical consultations and the National Coding Center (NCC) for account referrals.
• Complete medical records requests for audits and ensure timely submission to payers.
• Prepare, present, and track Government Audit Services projects and report their status to clients and leadership.
• Document cases clearly and communicate effectively with insurance agencies and CMS regarding audit and appeal activities.
• Address systemic root causes of recurring problems and provide operational guidance regarding revenue cycle policies and procedures.
• Identify system and operational issues and address them with Operations Leadership Team and Revenue Cycle Director.
• Utilize high-level problem-solving skills to identify issues and provide creative solutions to the Government Audit Leadership and business partners.
• Function as the next level of issue escalation for onsite support and departments.

Requirements

• High School Diploma required; Bachelor's Degree in Business or Healthcare preferred.
• 3 years of experience in Billing and Accounts Receivable Follow-Up, which can be a combination of both.
• 3-4 years of Medicare knowledge experience in resolving Medicare claims, with clear knowledge of UB04 billing requirements for Medicare.
• 1 year of customer service experience.
• Advanced knowledge of Excel and proficiency in all Microsoft Office products.
• Strong knowledge of coding terminology such as HCPCS, Diagnosis & ICD 10, DRG & Revenue Codes.
• Ability to work independently and exercise good judgment in problem-solving.
• Ability to train, coach, and mentor staff.

Nice-to-haves

• Ability to travel if needed to train staff.
• Strong leadership and organizational skills.

Benefits

• Competitive benefits package including health insurance, dental insurance, and vision insurance.
• Opportunities for professional development and career advancement.
• Support for ongoing education and skill development.