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 Clinical Authorization Services departmentalefficiencies which may include but not limited to verification of benefits,obtaining authorization requirements, and authorization requestsubmissions.
Collaborateswith department leaders in operational and quality excellence.
ESSENTIALDUTIES AND RESPONSIBILITIES
Includethe following. Others may be assigned.
Supportclinical pre-authorization services team as follows:
Â· Submits requestsfor authorizations for simple procedures as determine by leadership
Â· Triage accounts toidentify complex clinical requirement cases and/or escalate any issues toclinician for
o 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
Performsthe following activities to support the effective operation of theorganizationâs quality management system. A minimum of 2.5 % of time isspent carrying out the following responsibilities: Participation inquality control audit process; participation in department projects andactivities to improve overall Conifer and client scorecard metrics. Providesfeedback regarding improvement opportunities for workflow &/or procedures;and the contributes to successful implementation of all the above.
To perform this jobsuccessfully, an individual must be able to perform each essential dutysatisfactorily. The requirements listed below are representative of theknowledge, skill and/or ability required. Reasonable accommodations may be madeto 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
EDUCATION / EXPERIENCE
Includeminimum education, technical training, and/or experience preferred to performthe 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.
Â§Must be ableto 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.