Job Description

Summary

• The responsibilities of the individual in this position include but are not limited to the following : a) Follow up on patient accounts when authorization for stay is required, fax numbers to send clinical reviews;
• b) Follow up on each account during the stay and on discharge for authorization - document in the electronic system; c) Escalate any potential disputes or denial of accounts to Director of Case Management or designee;

d) Trends disputed claims by payor and physician; e) assist in obtaining authorization for patient discharged to Skilled Facilities or other post-acute care who require authorization and f) other duties as assigned.

Also provides general support for Case Managers with insurance cases, denials, appeals, etc. Provides assistance to Case Management staff, Insurance companies and Home Health Agency representatives in a positive and professional manner.

Maintains and demonstrates excellent organizational and communication skills in dealing with physicians, patients, public and members of the hospital staff when an assertive but tactful demeanor is required.

Maintains confidential files of correspondence, statistical reports and documents relative to operation and prepares confidential correspondence for the Case Management Team with little or no direction.

Coordinates, assists and advises on a variety of meetings, seminars, services and / or programs.

Qualifications

Education

Required : High school graduate or equivalent

Preferred : Associates or bachelor's degree; Nursing background

Experience

Proficiency in MS Word, Excel and PowerPoint presentation applications; Internet; Medical Terminology and / or Healthcare experience required.

Previous experience coordinating operations and management activities required. Acute hospital experience preferred

Required

Certification / Licensure / Registration

None required;

Paramedic, EMT or Nursing Assistant certification preferred

Other Qualifications

Demonstrated good problem solving abilities and organizational skills. Demonstrated ability to provide service excellence in daily activities.

Solid verbal and written communication skills

LI-RS1

Tenet complies with federal, state, and / or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date.

If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.

Responsibilities

No. Description % of Time

Support clinical pre-authorization services team as follows :

• Verify benefits and determine authorization requirements
• Submits requests for authorizations for simple procedures as determine by leadership
• Triage accounts to identify complex clinical requirement cases and / or escalate any issues to clinician for
• Peer to peer and / or denials

60% Customer Service - interaction with clients and Patient access staff. Facilitate / cooperate / collaborate on facilitating authorization process to include but not limited to requesting clarification on orders / requesting clinical / follow up on pending requests 20% Performs the following activities to support the effective operation of the organization's quality management system.

• A minimum of 2.5 % of time is spent carrying out the following responsibilities : Participation in quality control audit process;
• participation in department projects and activities to improve overall Conifer and client scorecard metrics. Provides feedback regarding improvement opportunities for workflow & / or procedures;

and the contributes to successful implementation of all the above. 2.5% Demonstrates proficiency in the use of multiple electronic tools required by both Conifer and its clients.

15% Other duties as assigned 2.5% FINANCIAL RESPONSIBILITY (Specify Revenue / Budget / Expense) : N / A SUPERVISORY RESPONSIBILITIES : N / A

Direct Reports (titles) N / A Indirect Reports (titles) N / A

Qualifications

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.

• 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
• Advanced understanding of compliance standards preferred
• High achievement in productivity
• 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

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment.

This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and / or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

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

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.

• 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

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.

• Characteristic of typical Call Center environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc.
• Resolves and as applicable escalates Physician's office and client issues
• May experience extreme case volumes and uncooperative parties

OTHER

• Must be available to work hours and days as needed (including weekends and holidays) based on departmental / system demands
• Resolves and as applicable escalates Physician's office and client issues
• May experience extreme case volumes and uncooperative parties

About Us

Who We Are

We are a community built on care. Our caregivers and supporting staff extend compassion to those in need, helping to improve the health and well-being of those we serve, and provide comfort and healing.

Your community is our community.

Our Story

We started out as a small operation in California. In May 1969, we acquired four hospitals, some additional care facilities and real estate for the future development of hospitals.

Over the years, we've grown tremendously in size, scope and capability, building a home in new markets over time, and curating those homes to provide a compassionate environment for those entrusting us with their care.

We have a rich history at Tenet. There are so many stories of compassionate care; so many "firsts" in terms of medical innovation;

so many examples of enhancing healthcare delivery and shaping a business that is truly centered around patients and community need.

Tenet and our predecessors have enabled us to touch many different elements of healthcare and make a difference in the lives of others.

Our Impact Today

Today, we are leading health system and services platform that continues to evolve in lockstep with community need. Tenet's operations include three businesses - our hospitals and physicians, USPI and Conifer Health Solutions.

Our impact spreads far and deep with 65 hospitals and approximately 510 outpatient centers and additional sites of care. We are differentiated by our top notch medical specialists and service lines that are tailored within each community we serve.

The work Conifer is doing will help provide the foundation for better health for clients across the country, through the delivery of healthcare-focused revenue cycle management and value-based care solutions.

Together as an enterprise, we work to save lives and can accept nothing less than excellence from ourselves in service of our patients and their families, every day.

About the Team

Careers at Tenet

At Tenet Healthcare, the heart of what we do centers on caring with compassion, which ultimately creates a bond between our caregivers and patients.

Everyone contributes to these moments, whether providing care directly or supporting those who do.

As an organization, we provide employees with resources, tools and support to serve our patients and customers in the best way possible.

We also take care of one another, helping team members further develop their career pathways and maximize their potential.

Last updated : 2024-04-23