Qureos Mentor

Heritage Medical Associates, P.C.

<div>Job Summary 
As a member of the HMA patient care delivery team, the RN may perform routine clerical, administrative, and clinical duties within the scope allowed under the TN Board of Nursing in order to ensure an operationally efficient, thorough, and positive patient experience. This position reports to the designated Site or Department Manager and may be assigned to a specific clinic/provider and/or float to various clinics/providers based on business needs and must demonstrate the ability to work collaboratively and effectively with physicians, providers, fellow team members, patients, and the general public in the performance of all job duties. In addition to the duties listed below, the RN may be required to perform other related duties as requested/assigned at a level that meets and/or exceeds HMA expectations. RN must be customer focused and driven to grow and to further develop a working culture consistent with HMA&rsquo;s mission, vision, values, and commitment to high standards of ethical and business conduct and compliance with all applicable laws and regulations and third party payer requirements.
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 accommodation may be made to enable individuals with disabilities to perform the essential functions.
JOB REQUIREMENTS:<ul><li>
Licensed Registered Nurse in the State of TN with at least 1-year experience in a preferably in a clinic or physician office setting (Specialties may include: OB/GYN, Dermatology, Gastroenterology, ENT/Otolaryngology, Rheumatology, Neurology, and Endocrinology etc.)</li><li>
Experience using electronic medical/health records</li><li>
Ability to work well in a team environment</li><li>
Ability to multi-task in a fast-paced environment</li></ul> 
EDUCATION and/or EXPERIENCE
<ul><li>Graduation from an accredited school of nursing RN program</li><li>
Minimum 1 year RN experience required (medical clinic setting preferred)</li></ul>
CERTIFICATES, LICENSES, REGISTRATIONS:<ul><li>
Valid unrestricted state of TN RN license</li><li>
Maintains Basic Cardiac Life Support Certification (CPR) and Advance Cardiac Life Support Certification Required for some specialties</li></ul>
PHYSICAL DEMANDS:
 
Physical guidelines include the ability to stand/walk up to eight hours/day; stoop, bend, twist. Assist patients in turning and arising from the exam table. Push wheelchair patients and assist a patient in arising from and returning to a wheelchair. Requires the ability to stand, sit, bend, reach overhead and carry 80 pounds, if necessary 
WORK ENVIRONMENT:
 
Clinical setting; exposure to communicable disease, medical preparations and other conditions common to a clinical environment.</div>

RN Specialty, Dr. Amy Valet, Dermatology, St. Thomas West

<div>SUMMARY: Insurance Analysts demonstrate thorough knowledge of the claims revenue cycle. The Insurance Analyst position is responsible for answering patient and staff inquiries, reviewing outstanding and/or denied insurance claims, submitting insurance appeals, and maintaining assigned insurance queues.
Insurance Analyst must have the ability to provide excellent Customer Service to patients and staff and correctly answer a question regarding insurance and balances. The type of questions may include, but are not limited to insurance participation, correct coding guidelines, carrier specific medical policies, and denial codes, review of accounts for payment application, as well as the ability to assist patient and/or staff in understanding insurance benefits and how the benefits were applied to the service(s) received at HMA.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following: (Other duties maybe assigned.)
<ul><li>Work denied claims through the practice management queue</li><li>
Processing of denials in a timely and accurate manner</li><li>
Correct and any denied claim, including submitting additional information or documentation as requested</li><li>
Creation and submission of appeals</li><li>
Communicate with insurance companies, as needed</li><li>
Query provider in a timely manner, as needed</li><li>
Interpret and apply compliance guidelines to maintain billing integrity</li><li>
Update and maintain patient account information and have the ability to make adjustments as necessary, and according to company policy</li><li>
Receive, sort and work incoming correspondence daily</li><li>
Identify and communicate trends in denials to management</li><li>
Answer patient questions, inquiries and concerns regarding their accounts; verify balances and refunds for accuracy, and ensure timely follow up with patient, as needed.</li><li>
Audit accounts referred by Patient Service Representatives and Patient Accounts, as well as provide a response in a timely manner</li><li>
Utilize the Insurance Analyst work queues to follow up on accounts until the account has been satisfactorily resolved.
</li><li>Post corrected claims and any payments associated with that correction</li><li>
Transfer credits in an account</li><li>
Follow HMA guidelines in applying self-pay discounts, charity and per request adjustments.
</li></ul>SUPERVISORY RESPONSIBILITIES:
None
QUALIFICATIONS:
<ul><li>Strong Customer Service Skills</li><li>
Excellent telephone etiquette and skills</li><li>
Exceptional written and verbal communication skills</li><li>
Ability to work with little supervision</li><li>
Superior organizational skills</li><li>
Self motivated</li><li>
Ability to work in a cooperative manner with others</li><li>
Regular and predictable attendance</li></ul>
EDUCATION and/or EXPERIENCE:<ul><li>
High school diploma</li><li>
3-5 years of third-party billing in a physicians office</li><li>
Knowledge of ICD-10/CPT Coding</li><li>
Experience in medical billing systems
</li><li>Must have thorough understanding of Medicare/Medicaid laws, managed care, and commercial health insurance</li></ul>
<h4 class="jobSectionHeader">PHYSICAL DEMANDS:</h4><ul><li>
Must be able to walk to patient in physicians office and/or sit for 8 to 10 hours a day</li><li>
Requires regular walking, bending, pushing, pulling, twisting and lifting</li><li>
Must be able to lift at least 10-15lbs</li><li>
Ability to delineate between numeric numbers</li></ul><h2 class="jobSectionHeader">
WORK ENVIRONMENT:</h2><ul><li>
Office environment-limited exposure to communicable diseases.
</li><li>No exposure to blood-borne pathogens or contaminated body fluids
</li><li>Fast paced environment</li></ul></div>

Insurance Analyst, Business Office, Nashville

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Heritage Medical Associates, P.C.

About Company

RN Specialty, Dr. Amy Valet, Dermatology, St. Thomas West

Insurance Analyst, Business Office, Nashville