As a part of the Tenet and Catholic Health Initiativesfamily, Conifer Health brings 30 years of healthcare industry expertise toclients in more than 135 local regions nationwide. We help our clientsstrengthen their financial and clinical performance, serve their communitiesand succeed at the business of healthcare. Conifer Health helps organizationstransition from volume to value-based care, enhance the consumer and patienthealthcare experience and improve quality, cost and access to healthcare. Areyou ready to be part of our solutions? Welcome to the company that gives you the resources and incentives toredefine healthcare services, with a competitive benefits package andleadership to take your career to the next step!
Responsiblefor a wide range of duties in support of CAS departmental efficiencies whichmay include but not limited to verification of benefits, obtainingauthorization requirements, and authorization request submissions.Collaborates with CAS department leaders inoperational and quality excellence.
ESSENTIALDUTIES AND RESPONSIBILITIES
Include the following. Othersmay be assigned.
Supportclinical pre-authorization services team as follows:
Verifybenefits and determine authorization requirements
Submitsrequests for authorizations for simple procedures as determine by leadership
Triageaccounts to identify complex clinical requirement cases and/or escalate anyissues to clinician for
Peer to peer and/or denials
Complexcases needing authorization i.e. surgery/wound care/chemo/complex RAD formedical necessity clinical pre-authorization.
CustomerService â interaction with clients and Patient access staff. Facilitate /cooperate/collaborate on facilitating authorization process to include but notlimited to requesting clarification on orders/requesting clinical/follow up onpending requests
Performs the following activities to support theeffective operation of the organizationâs quality management system.A minimum of 2.5 % of time is spent carryingout the following responsibilities:Participation in quality control audit process; participation indepartment projects and activities to improve overall Conifer and clientscorecard metrics. Provides feedback regarding improvement opportunities forworkflow &/or procedures; and the contributes to successful implementationof all the above.
Toperform this job successfully, an individual must be able to perform eachessential duty satisfactorily. The requirements listed below are representativeof the knowledge, skill and/or ability required. Reasonable accommodations maybe made to enable individuals with disabilities to perform the essentialfunctions.
Minimum typing skills of 35 wpm
Demonstrated working knowledge of software/system/equipment
Knowledge of function and relationships within a hospital / physician office environment preferred
Advance customer service skills and experience
Ability to work in a fast paced environment
Ability to receive and express detailed information through oral and written communications
Skill in Medical Terminology required
Advanced understanding of third party payer requirements preferred
Builds and maintains collaborative relationships with both internal and external clients that lead to more effective communication and a higher level of productivity and accuracy
Include minimum education,technical training, and/or experience preferred to perform the job.
High School Diploma or GED required
2-4 years experience in medical facility, health insurance, or related area
Some college coursework is preferred
Thephysical demands described here are representative of those that must be met byan employee to successfully perform the essential functions of this job.Reasonable accommodations may be made to enable individuals with disabilitiesto perform the essential functions.
Must be able to sit at computer terminal for extended periods of time
Occasionally lift/carry items weighing up to 25 lbs.
Frequent prolonged standing, sitting, and walking
Job: Patient Access
Primary Location: Lebanon, New Hampshire
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâs or employeeâs 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.