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 Supervisor is responsible for the supervision and leadership of the CRC clinicians and/or coding audit specialist, a team of telecommuters. This individual is directly responsible for scheduling training with the CRC educators and ensuring that all access is requested in e-ID, secured by the respective clinician and that each clinician is able to successfully log in to the application in the new employeeâ��s assigned market. The supervisor will also assist with the following tasks:
Inventory management and reconciliation of accounts worked each day
Assist with the Identification of performance deficiencies and escalate to the manager or other unit leaders as appropriate.
Respond timely to all escalations/questions, including completion of accounts referred to the Supervisor for work efforts
Other duties as assigned.
Effectively maintain a work environment which promotes communication to stimulate the morale, engagement and growth of subordinates.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Other duties may be assigned.
Responsible for all aspects of the day-to-day supervision and leadership of CRC clinicians and/or coding audit specialists, including but not limited to the performance management metrics associated with productivity, quality and aging.
Schedule training with the CRC Educators, develop, motivate and assist subordinates in reaching new levels of skills, knowledge and attitude. Effectively maintain a work environment which stimulates and motivates the morale, engagement and growth of subordinates. Identify performance deficiencies and opportunities and escalate to the manager or other unit leaders as needed.
Review and respond timely to requests, including emails, issues, account research and resolution as needed by staff, and management. Timely completion of accounts referred by staff or management.
Effectively communicate and interact with subordinates, management and clients.
Performs retrospective (post-discharge) medical necessity reviews to determine appellate potential of clinical disputes/denials or those eligible for clinical review
If direct report positions are listed below, the following responsibilities will be performed in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include: scheduling training of new employees; planning, assigning and directing work; performance management; escalating clinician/client complaints and resolving problems.
Clinician, RC Appellate
Spec, CRC Coding Audit
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.
Demonstrates proficiency in the application of medical necessity criteria tools
Possesses excellent written, verbal and professional letter writing skills
Critical thinker, able to make decisions independently
Ability to interact intelligently and professionally with other clinical and non-clinical partners
Demonstrates understanding of managed care contracts including reimbursement matrixes and terms
Ability to multi-task
Ability to conduct research on topics relevant to appeals, for example, off-label use of medications or State/Federal appellate guidelines
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience required to perform the job.
Must possess a valid nursing license (Registered or Practical/Vocational)
Minimum of 5 years acute care experience preferred
Minimum of 3 years appellate nursing experience
Managed care payer experience preferred either in Utilization Review, Case Management or Appeals
Patient Accounting experience preferred
Previous experience using medical necessity tool (example: InterQualâ® or MCGâ® criteria) preferred
EDUCATION / EXPERIENCE
4-7 yearsâ�� experience preferred
Knowledge of UB-04, EOB interpretation, CPT and ICD-9 codes.
Supervisory experience or demonstrated leadership.
CERTIFICATES, LICENSES, REGISTRATIONS
Current, valid RN/LPN/LVN licensure
Certified Case Manager (CCM) or Certified Professional in Utilization Review/Utilization Management (CPUR or CPUM) preferred
Experience and/or certification in medical coding (example: RHIA, RHIT and/or CCS) and/or clinical documentation integrity specialist (example: CCDS and/or CDIP)
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.
Ability to lift 15-20lbs
Ability to travel approximately 10% of the time; either to facility sites, Regional Business Office sites, Headquarters or other designated sites
Ability to sit and work at a computer for a prolonged period of time conducting medical necessity reviews and performing appellate activity
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.
Characteristic of typical office environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc.
Creative and innovate thinking
Achieves results with accuracy and precision
Advanced knowledge of Clinical appeals
Excellent working knowledge of AR Management/clinical appeals on Inpatient and Outpatient Managed Care and Commercial payers (i.e., Medicare regulations and compliance; HIPAA)
Proficient in Microsoft Office (Word and Excel)
Advanced writing skills
Ability to provide advanced customer service
Ability to train and coach staff
Ability to multi-task
Strong leadership and organizational skills
Job: Conifer Health Solutions
Primary Location: Frisco, Texas
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: 2105015771
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.