Tenet Healthcare Corporation Westminster , CA 92683
Posted 2 weeks ago
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!
JOB SUMMARY
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 initiated 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 - Word and Excel
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
Bachelor's Degree preferred
IPA/Hospital collection experience preferred
Experience working with Providers and Health Plans preferred
Experience with EZcap 6x preferred
REQUIRED CERTIFICATIONS/LICENSURE
Include minimum certification required to perform the job.
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 work in sitting position, use computer and answer telephone
Light physical effort (lift up to 10lbs)
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.
TRAVEL
Compensation and Benefit Information
Compensation
Pay: $22.40-$33.71 per hour.
Shift differentials of $1.00-$2.50/per hour may be available depending on the shift worked.
Conifer observed holidays receive time and a half.
Benefits
Conifer offers the following benefits, subject to employment status:
Medical, dental, vision, disability, and life insurance
Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
401k with up to 6% employer match
10 paid holidays per year
Health savings accounts, healthcare & dependent flexible spending accounts
Employee Assistance program, Employee discount program
Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
2305051313
Tenet Healthcare Corporation