Tenet Healthcare Terms & Conditions Analyst in Boca Raton, Florida
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 Contract Coordinator is responsible for healthcare insurance reimbursement accuracy; assisting with validation of contract loads and maintenance in the claims adjudication system by reporting discrepancies to the Contract Analyst based on review of daily production and exception detail processing reports; collaborate with key stakeholders for the resolution and feedback of related issues.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Others may be assigned.
Works the contract system daily processing reports, daily payor change reports and daily account research from work list reports and reviews for improperly adjudicated accounts.
Works other weekly, bi-monthly and month end reporting queries and reviews for improperly adjudicated accounts.
Assists other NIC functional areas with other processes as needed.
Creates and maintains system tables for specific coding, billing, and appeals addresses.
Communications to key stakeholders as 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.
Knowledge or experience in reviewing the Terms and Conditions of managed care contract
Intermediate understanding of hospital billing form requirements (UB-04)
Intermediate understanding of ICD-9 HCPCS/CPT coding and medical terminology
Intermediate Microsoft Office (Word, Excel)
Intermediate knowledge of query writing applications a plus
Knowledge of Contract Adjudication applications
Strong communication skills (verbal and written)
Intermediate managed care/government contract interpretation skills
Strong analytical abilities
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
High School diploma or equivalent
3-5 years of relevant hospital business office experience preferred
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
Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments
Ability to lift and/or move up to 25 pounds
Specific vision abilities required by this job include close vision.
Ability to travel
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
Title: Terms & Conditions Analyst
Location: FL-Boca Raton
Requisition ID: 1805009815