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!
Responsible for a wide range of duties in support of Clinical Authorization Services departmental efficiencies which may include but not limited to verification of benefits, obtaining authorization requirements, and authorization request submissions.
Collaborates with department leaders in operational and quality excellence.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Support clinical pre-authorization services team as follows:
â· Verify benefits and determine authorization requirements
â· Submits requests for authorizations for simple procedures as determine by leadership
â· Triage accounts to identify complex clinical requirement cases and/or escalate any issues to clinician for
o Peer to peer and/or denials
Complex cases needing authorization i.e. surgery/wound care/chemo/complex RAD for medical necessity clinical pre-authorization.
Customer Service â�� 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
Performs the following activities to support the effective operation of the organizationâ��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.
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
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
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.
â§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 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.
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