Provider Practice Coordinator
Company: Tenet Healthcare Corporation
Location: Westminster
Posted on: June 20, 2022
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Job Description:
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!
JOB SUMMARY
Accountable for a wide range of duties in support of client
management activities, including but not limited to, research and
resolve client operational and provider financial issues (provider
disputes, claims and utilization management issues). Accountable
for the client membership and enrollment activity, including but
not limited to, contract negotiations. Accountable for the client
administrative support, such as, answer phone calls, track issues,
update calendar, draft board minutes, prepare board packets, and
schedule meetings.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
* Accountable to log and resolve customer service incidents,
research provider claims and utilization management issues,
investigate and resolve the underlying root cause of repeat
provider claim disputes or referral issues, validate provider
system set up and configuration, ensure accurate and correct
provider fee schedules set up.
* Manage enrollment activitiy and identify variances in monthly
membership reports. Responsilbe to track changes at the primary
care provider level. Develop action plan to address membership
changes and work with provider representative to increase
membership for the client.
* Identify and resolve provider network adequacy and/or specialty
need required for client provider network. Provide and track all
in-house client issue and resolution support for the Provider
Practice teams.
* Negotiate terms for letter of understanding (LOU) agreements,
draft, send, and obtain signed LOUs
* Prepare board, UM, and QM minutes and packets, document and
manage customer service incidents and action logs, close out action
items, and draft minutes and agendas
* Provide general office support such as, copying, scanning,
indexing, of provider contracts
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
activity. 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
Candidates that exhibit most of the following preferred
qualifications will be well suited for this position. However,
* 2-4 years of experience in a medical setting, health insurance or
related area
* 2 years in managed care experience preferred
* Working knowledge of risk bearing organization and the delegated
UM, Credentialing, Network Management, Customer Service, Finance,
and Case Management.
* Intermediate MS Office required (Outlook, Excel, Word, and
PowerPoint). Excel Pivot Tables and Access skills a plus. OR
* Entry level self-starter and career minded interested in
healthcare field and
* Intermediate MS Office required (Outlook, Excel, Word, and
PowerPoint). Excel Pivot Tables and Access skills a plus.
EDUCATION / EXPERIENCE
* Bachelor Degree or higher 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 work in a sitting position, use a computer and
answer telephone
* Light physical effort (lift to 10 lbs.).
* The home office for this position will be located in Encino,
CA.
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.
* Office Work Environment
* Hospital Work Environment
TRAVEL
* This position requires local travel (within 50-mile radius) at
least 35% of the time.
Keywords: Tenet Healthcare Corporation, Westminster , Provider Practice Coordinator, Other , Westminster, California
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