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 Senior Analyst Terms and Conditions is responsible for healthcare insurance reimbursement analysis. At the base level, a Terms and Conditions Analyst has a strong understanding of contract and payors, and validates proper claims pricing based on loaded contracts and applies independent judgment in the maintenance of the claims adjudication system. The Senior Analyst Terms and Conditions will display mastery of the Terms and Conditions Analyst role and analyze data to assist in trending contract and payor behavior for all facilities, formulating and implementing system improvements and acting as a subject matter expert on analytical trending. The Senior Analyst Terms and Condition will illuminate findings and collaborate with key stakeholders for the resolution of related issues.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Analyzes contract and market behaviors in a timely manner and formulates/implements solutions
Regularly exercises discretion in analyzing and identifying issues. Formulates and implements solutions to identified issues and is empowered to make exceptions when required to move issues to resolution.
Review and interpret dashboard and exception reports, including credit reports, Showcase, nthrive worklist and ATB review
Trending - finds multiple examples to communicate findings.
Special projects based on business need
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.
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.
This position requires knowledge of and the ability to perform all functions of the Contract Analyst.
Strong analytical abilities
Ability to provide precise, well-organized metrics and communicate findings
Articulate and self-motivated â�� ability to move past prior concepts and see opportunities to develop a new path regarding T&C responsibilities
Advanced Microsoft Office (Word, Excel)
Advanced understanding of hospital billing form requirements (UB-04)
Advanced understanding of ICD-9, HCPCS/CPT coding and medical terminology
Advanced knowledge of query writing applications a plus
Include minimum education, technical training, and/or experience required to perform the job.
Minimum 2 years contract interpretation experience required
Terms and Conditions Analyst experience desirable
Bachelor or Associate Degree preferred
3-5 years of relevant hospital business office experience preferred
Must be able to implement a systematic, self motivated approach to problem solving and be able to identify, coordinate and optimize resources needed to execute plans
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 lift and/or move up to 25 pounds
Specific vision abilities required by this job include close vision.
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
Other duties as assigned
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.
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.