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!
JOB SUMMARY Responsible for a wide range of duties in support of Patient Service Center (PSC) departmental efficiencies which may include but not limited to verification of benefits, obtaining authorization requirements, and authorization request submissions. Collaborates with PSC department leaders in operational and quality excellence. Demonstrates proficiency in the use of multiple electronic tools required by both Conifer and its clients.
ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned.
Support clinical pre-authorization services team as follows: â�¢ Verify benefits and determine authorization requirements â�¢ Secure required authorizations for inpatient, outpatient and emergency services. â�¢ Address complex issues requiring clinical input and/or escalation (e.g. Peer to peer and/or denials) Builds and maintains collaborative relationships with both internal and external clients. Interact with clients and revenue cycle staff to facilitate the authorization process. Process includes but not limited to requesting clarification on orders, validating clinical documentation and follow up on pending requests. Support the effective operation of the organizationâ��s quality management system through participation in quality control audit process, department projects and activities to improve overall scorecard metrics. Provides feedback regarding improvement opportunities for workflow and contributes to successful implementation.
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.
â�¢ Minimum typing skills of 35 wpm â�¢ Demonstrated working knowledge of software/system/equipment â�¢ Knowledge of function and relationships within a hospital / physician office environment preferred â�¢ Advanced customer service skills and experience â�¢ Ability to work in a fast paced environment â�¢ Ability to receive and express detailed information through oral and written communications â�¢ Knowledge of Medical Terminology preferred â�¢ Advanced understanding of third party payer requirements preferred â�¢ Advanced understanding of healthcare compliance standards preferred â�¢ Ability to multi-task and manage time effectively
EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience preferred to perform the job.
â�¢ High School Diploma or GED required â�¢ 2-4 years experience in medical facility, health insurance, or related area â�¢ Some college coursework is preferred
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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
â�¢ Must be able to sit at computer terminal for extended periods of time â�¢ Occasionally lift/carry items weighing up to 25 lbs. â�¢ Frequent prolonged sitting and walking
WORK ENVIRONMENT 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.
â�¢ Call Center environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc.
â�¢ Must be available to work hours and days as needed (including weekends and holidays) based on departmental/system demands â�¢ Resolves and as applicable escalates Physician's office and client issues â�¢ May experience extreme case volumes and uncooperative parties
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: 2105008783
About Conifer Health Solutions
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.