As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
Responsible for the review of accounts where the patient is covered under an Out of State Medicaid program to ensure all the appropriate enrollment forms are submitted in a timely and efficient manner.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Review and work the MEPRVWOOS delegation control ID, and desks in the following branches 70, 71, 72, 75, 78 and 79.
Thoroughly verify coverage for patients that present Medicaid from states other than the state in which they are receiving care.
Perform follow-up on submitted enrollment applications within 30-45 days on status. (timelines dependent on state)
Dispute and or appeal any enrollment applications that have been unjustly denied.
Maintain a list of OOS application requirements.
Request updated W9, JACHO, CLIA License, etc from key contacts as needed.
KNOWLEDGE, SKILLS, ABILITIES
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.
Working familiarity with the rules and regulations pertaining to Federal, State and County programs
P/C systems literate including Windows, and Microsoft Outlook, Excel and Word programs
Ability to work independently
Excellent oral and written communication skills, as well as the clear understanding of the English language
Detail oriented, with strengths in dealing with multiple facilities, Supervisors, and Hospital platforms
Ability to prioritize and manage multiple tasks with efficiency
Valid Driverï¿½s License and auto insurance
Bi-lingual preferred (Spanish)
Other duties as assigned
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
High School diploma or equivalent
Minimum 2 years work experience with Social Services or Hospital Admitting or related area
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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Must be able to work in sitting position, use computer and answer telephone
Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments
Ability to lift and/or move up to 25 pounds
Specific vision abilities required by this job include close vision.
Ability to travel
Must be able to drive short distances
Must be able to navigate in a hospital environment and visit patients at bedside, if needed
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Office Work Environment
Hospital Work Environment
Job: Conifer Health Solutions
Primary Location: Frisco, Texas
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Internal Number: 1905024825
About Conifer Health Solutions
“Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans.