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!
Performs provider outreach for all outstanding refunds for all managed groups. Engages with providers and payers on issues pertaining to overpaid claims and reimbursement. Creates incidents to update issues found regarding contracts, eligibility claims processing.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Provider Outreach for outstanding and provider inititated refunded requests, via phone/fax/email
Reviews dashboard to address past due refund requests. Addresses overpaid claims due to system errors, claims processing errors and other discrepancies. Coordinate discrepancies to supervisor
Assist when needed to help post refund checks by coding refunds received and entering refunded amount in EZ Cap for monthly reconciliation
Assist with maintaining Macess Document Management system
Assist with overpayments identified through the capitation deduction audits
Perform all other job related duties and special projects as it relates to the job function or as delegated by the management
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.
Effective writing and communication skills
Demonstrated analytical and problem solving skills
Partner effectively within a matrixed organization
Proficient with Microsoft Office Software â�� Word and Excel
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
High School Diploma or GED
Bachelorâ��s Degree preferred
IPA/Hospital collection experience preferred
Experience working with Providers and Health Plans preferred
Experience with EZcap 6x preferred
Include minimum certification required to perform the job.
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 sitting position, use computer and answer telephone
Light physical effort (lift up to 10lbs)
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
Job: Conifer Health Solutions
Primary Location: Encino, 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: 2105016456
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.