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!
Accountable for a wide range of duties in support of client management activities, including but not limited to, research and resolve client operational and provider financial issues (provider disputes, claims and utilization management issues). Accountable for the client membership and enrollment activity, including but not limited to, contract negotiations. Accountable for the client administrative support, such as, answer phone calls, track issues, update calendar, draft board minutes, prepare board packets, and schedule meetings.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Accountable to log and resolve customer service incidents, research provider claims and utilization management issues, investigate and resolve the underlying root cause of repeat provider claim disputes or referral issues, validate provider system set up and configuration, ensure accurate and correct provider fee schedules set up.
Manage enrollment activitiy and identify variances in monthly membership reports. Responsilbe to track changes at the primary care provider level. Develop action plan to address membership changes and work with provider representative to increase membership for the client.
Identify and resolve provider network adequacy and/or specialty need required for client provider network. Provide and track all in-house client issue and resolution support for the Provider Practice teams.
Negotiate terms for letter of understanding (LOU) agreements, draft, send, and obtain signed LOUs
Prepare board, UM, and QM minutes and packets, document and manage customer service incidents and action logs, close out action items, and draft minutes and agendas
Provide general office support such as, copying, scanning, indexing, of provider contracts
This position reports to the Manager, Provider Practice and requires some degree of supervision to ensure client day to day issues are prioritized and timely and accurately recorded and implemented.
KNOWLEDGE, SKILLS, ABILITIES
Candidates that exhibit most of the following preferred qualifications will be well suited for this position. However,
2-4 years of experience in a medical setting, health insurance or related area
2+ years in managed care experience preferred
Working knowledge of risk bearing organization and the delegated UM, Credentialing, Network Management, Customer Service, Finance, and Case Management.
Intermediate MS Office required (Outlook, Excel, Word, and PowerPoint). Excel Pivot Tables and Access skills a plus. OR
Entry level self-starter and career minded interested in healthcare field and
Intermediate MS Office required (Outlook, Excel, Word, and PowerPoint). Excel Pivot Tables and Access skills a plus.
EDUCATION / EXPERIENCE
Bachelorâ��s degree or higher preferred
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 a sitting position, use a computer and answer telephone
Light physical effort (lift to 10 lbs.).
The home office for this position will be located in Encino, CA.
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
This position requires local travel (within 50-mile radius) at least 35% of the time.
Job: Conifer Health Solutions
Primary Location: Westminster, California
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: 2105021623
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.