JOB SUMMARY
Responsible for a wide range of duties in support of Patient Service Center
(PSC) departmental efficiencies which may include but not limited to
verification of benefits, obtaining authorization requirements, and
authorization request submissions. Collaborates with PSC department leaders in
operational and quality excellence. Demonstrates proficiency in the use of
multiple electronic tools required by both Conifer and its clients.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Support clinical pre-authorization services team as follows:
Verify benefits and determine authorization requirements
Secure required authorizations for inpatient, outpatient and emergency
services.
Address complex issues requiring clinical input and/or escalation (e.g.
Peer to peer and/or denials)
Builds and maintains collaborative relationships with both internal and
external clients. Interact with clients and revenue cycle staff to
facilitate the authorization process. Process includes but not limited to
requesting clarification on orders, validating clinical documentation and
follow up on pending requests.
Support the effective operation of the organization’s quality management
system through participation in quality control audit process, department
projects and activities to improve overall scorecard metrics. Provides
feedback regarding improvement opportunities for workflow and contributes to
successful implementation.
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
Advanced 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
Knowledge of Medical Terminology preferred
Advanced understanding of third-party payer requirements preferred
Advanced understanding of healthcare compliance standards preferred
Ability to multi-task and manage time effectively
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 required
2-4 years experience in medical facility, health insurance, or related area
Some college coursework is preferred
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 sit at computer terminal for extended periods of time
Occasionally lift/carry items weighing up to 25 lbs.
Frequent prolonged sitting and walking
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.
Call Center environment requiring use of desk, chair, and office equipment
such as computer, telephone, printer, etc.
OTHER
Must be available to work hours and days as needed (including weekends and
holidays) based on departmental/system demands
Resolves and as applicable escalates Physician’s office and client issues
May experience extreme case volumes and uncooperative parties
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!
Compensation and Benefit Information
Compensation
Pay: $15.80 - $23.70 per hour. Compensation depends on location,
qualifications, and experience.
Position may be eligible for a signing bonus for qualified new hires, subject
to employment status.
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.
For Colorado employees, Conifer offers paid leave in accordance with
Colorado’s Healthy Families and Workplaces Act.