Job Abstract

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

Performs provider outreach for all outstanding refunds for all managed groups. Engages with providers and payers on issues pertaining to overpaid claims and reimbursement. Creates incidents to update issues found regarding contracts, eligibility claims processing.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Provider Outreach for outstanding and provider initiated refunded requests, via phone/fax/email
• Reviews dashboard to address past due refund requests. Addresses overpaid claims due to system errors, claims processing errors and other discrepancies. Coordinate discrepancies to supervisor
• Assist when needed to help post refund checks by coding refunds received and entering refunded amount in EZ Cap for monthly reconciliation
• Assist with maintaining Macess Document Management system
• Assist with overpayments identified through the capitation deduction audits
• Perform all other job related duties and special projects as it relates to the job function or as delegated by the management

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.

• Effective writing and communication skills
• Demonstrated analytical and problem solving skills
• Partner effectively within a matrixed organization
• Proficient with Microsoft Office Software – Word and Excel

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.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• High School Diploma or GED
• Bachelor’s Degree preferred
• IPA/Hospital collection experience preferred
• Experience working with Providers and Health Plans preferred
• Experience with EZcap 6x preferred

REQUIRED CERTIFICATIONS/LICENSURE

Include minimum certification required to perform the job.

• N/A

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 sitting position, use computer and answer telephone
• Light physical effort (lift up to 10lbs)

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

TRAVEL

• N/A

Compensation and Benefit Information

Compensation

• Pay: $22.40-$33.71 per hour.
• Shift differentials of $1.00-$2.50/per hour may be available depending on the shift worked.
• Conifer observed holidays receive time and a half.

Benefits

Conifer offers the following benefits, subject to employment status:

• Medical, dental, vision, disability, and life insurance
• Paid time off (vacation & sick leave) – min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.