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 the client relationship and financial performance, which may include, but not limited to working closely with claim operations to ensure proper claims management, participate and lead client meetings to discuss open issues and coordinate with various departments to ensure that client issues are resolved timely.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Works collectively with all levels of management and staff to ensure compliance with inventory production and timeliness standards including but not limited to QC, T&C, Eligibility, UM, Compliance, and Operations Departments.
Monitors claims inventory report and works with the claim operations to resolve any issues. Reviews daily operational reports throughout the day to assure compliance. Reviews daily production reports to monitor and counsel staff not meeting the established production requirements.
Responsible for client meetings, which may include, but not limited to preparing agenda items, tracking action logs and preparing AR packets.
Accountable for the timely and accurate implementation of the delegated services to the client and escalation path when barriers, obstacles, and/or challenges may result in missed deliverables. Responsible for identification of issues and provide workable solutions and/or options to ensure client performance and/or objectives are met.
Manage and track client issues and coordinate with operational teams to address and resolve client issues. Prepare and gather materials to comply with payor health provider network audits.
Accountable for existing client growth targets are achieved and new services/upsell opportunities are realized, including but not limited, adherence to the change control notice (CCN) and deal review committee processes (DRC I and II). Serve as subject matter expert for new client logos.
Work with operational and functional department teams to ensure that client business objectives are executed on time.
ï�· This position reports to the Director, West Region Provider Practice and requires moderate degree of supervision to ensure strategic initiatives and client expectations are prioritized, met, and successfully implemented.
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 activity. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.
KNOWLEDGE, SKILLS, ABILITIES
Candidates that exhibit most of the following preferred qualifications will be well suited for this position. However,
2+ years experience with hospital claim operations
2-4 years of health plan or management service organization experience in managing risk bearing organizations or related area
2+ years in managed care experience preferred
General working knowledge of the risk bearing organization and the delegated UM, Credentialing, Network Management, Customer Service, Finance, and Case Management functions.
General working knowledge of risk bearing operating and performance revenue and expense levers
General working knowledge of payor strategies and market layout.
EDUCATION / EXPERIENCE
Bachelor Degree or higher
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 ï�· 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
ï�·This position requires local (50-mile radius) travel at least 30% of the time.
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.
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.