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!
The primary purpose of the Managed Care Analyst is to perform analysis of managed care contracts and agreements. This includes research on the specifics of doing business with our Managed Care clients. The position requires a solid understanding of government payors and other commercial/managed care carrier processes. The individual will be required to manage multiple projects and timelines.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Serve as primary analyst of managed care information, such as health plan specific policies, to internal departments.
Conduct research to assist in development of policies and procedures, manuals and other internal documentation when necessary.
Maintain fee schedule and contract database by collecting client contracts and loading terms and preparing fee schedules.
Analyze payment data related to client manage care contracts to ensure payor compliance. Communicate results to leader.
Coordinate claim reprocessing projects when necessary.
Research managed care contracts for negotiation purposes when necessary.
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.
Compliance with Laws, Policies and Procedures: Adheres to company handbook and policies. Demonstrates behavior consistent with Code of Conduct. Adheres to compliance program and guidelines.
Communicates Effectively: Expresses ideas clearly and succinctly with small or large audiences. Listens attentively to speakerâ��s message without interruption. Tailors writing to audience using correct grammar and spelling.
Develops Self: Seeks opportunities for continuous learning. Modifies behavior in response to feedback. Knows personal strengths and weaknesses and demonstrates ownership for personal development.
Drives for Results: Delivers high quality work and attains results. Demonstrates personal drive and pushes self and others for results and quality work. Responds appropriately to urgent situations.
Plans and Organizes Effectively:Prioritizes the importance of tasks and goals. Manages time efficiently in order to accomplish priorities and overcome obstacles. Effectively manages resources and schedules to meet goals. Organizes information so it can be easily found.
Analyzes Information:Determines information necessary to solve a problem. Avoids getting bogged down in unnecessary detail. Identifies the root cause of problems.
Displays Adaptability: Performs well in high pressure or stressful situations. Works effectively when direction is unclear or rapidly changing. Demonstrates persistence in the face of obstacles.
Focus on the Customer/Client: Ensures that clients have a positive experience. Responds to clients in a timely manner. Demonstrates tact and empathy when responding to clients.
Builds Effective Teams: Selects team members effectively. Fosters an environment of trust among team members. Encourages employees to work together to accomplish goals.
Empowers Others: Delegates effectively based on skills and workload. Encourages and supports independent decisions. Provides Employees with necessary information and resources.
Holds Others Accountable:Establishes clear expectations for employees and team. Follows-up with Employees to ensure deadlines are met. Provides feedback that is timely, clear, and honest. Identifies and manages unacceptable performance.
Manages Conflict:Does not avoid conflict situations. Effectively conveys a difference of opinion. Resolves conflict in a constructive manner.
Motivates Others:Inspires others to work toward goals. Modifies motivational approach based on the individual. Recognizes individual accomplishments and team successes.
Builds Team Relationships: Invites others to share opinions. Partners with employees in other departments. Actively seeks ways to help team members.
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
5 years managed care experience within a managed care organization, physician, IPA or billing environment with experience in revenue cycle management and managed care contracting related fields
Comprehensive understanding of reimbursement methodologies, fee schedules, HCPCS, CPT4, ICD9, CCI edits, and industry standard physician billing and claims adjudication practices
Knowledge of EPIC and IDX billing systems 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
Ability to travel
Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments
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
Hospital Work Environment
Job: Process & Analyst
Primary Location: Tinley Park, Illinois
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: 2105012988
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.