UNKNOWN

ADAPTED_NOW

Succinctly abstracts fact based clinical information to support pre-authorization utilizing applicable nationally recognized and payer-specific criteria; communicates timely the clinical information supporting the medical necessity of an ordered test/treatment/procedure/surgery as applicable to the patient’s health plan and documents the outcome of the task. The Revenue Cycle Management Clinician for the Pre-Authorization Solution is responsible for: a) All clinical pre-authorization activities associated with patients financially cleared through the Patient Access Support Unit (PASU) and/or the Center for Patient Access Services (CPAS).

<h3>Job Summary</h3>Spanish Bilingual RequiredJOB SUMMARYThe Revenue Cycle Management Clinician for the Pre-Authorization Solution is responsible for:a) All clinical pre-authorization activities associated with patients financially cleared through the Patient Access Support Unit (PASU) and/or the Center for Patient Access Services (CPAS).b) Coordinating with ordering physicians and/or facility staff to secure the necessary prior payment authorization utilizing applicable payer criteria.Include the following. Others may be assigned.ESSENTIAL DUTIES AND RESPONSIBILITIES<ul><li>Performs pre-service authorization reviews to obtain payment authorization for both inpatient and outpatient services. Succinctly abstracts fact based clinical information to support pre-authorization utilizing applicable nationally recognized and payer-specific criteria; communicates timely the clinical information supporting the medical necessity of an ordered test/treatment/procedure/surgery as applicable to the patient’s health plan and documents the outcome of the task.</li><li>Performs the following activities to support the effective operation of the organization’s quality management system. A minimum of 2.5 % of time is spent carrying out the following responsibilities: Participation in quality control audit process; participation in department projects and activities to improve overall Conifer and client scorecard metrics. provides feedback regarding improvement opportunities for workflow &/or procedures; and the contributes to successful implementation of all the above.</li><li>Demonstrates proficiency in the use of multiple electronic tools required by both Conifer and its clients. </li><li>Collaborate with and engage internal and external customers, such as facility patient access and physician offices, in opportunities for prevention of future disputes; identifies potential process gaps and recommends sound solutions to CAS leadership. </li><li>Other duties as assigned </li></ul>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.<ul><li>Ability to work independently and self-regulate in compliance with deadlines</li><li>Proficiency in the application of applicable nationally and payer authorization criteria</li><li>Possesses excellent customer service skills that include written and verbal communication.</li><li>Minimum Intermediate Microsoft Office (Excel and Word) skill</li><li>Ability to critically think, problem solve and make independent decisions </li><li>Ability to interact intelligently and professionally with other clinical and non-clinical partners</li><li>Ability to prioritize and manage multiple tasks with efficiency</li><li>Advanced conflict resolution skills</li><li>Ability to communicate effectively at all levels</li><li>Ability to conduct research regarding payer pre-authorization guidelines and applicable regulatory processes related to the pre-authorization process</li></ul>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 / EXPERIENCEInclude minimum education, technical training, and/or experience required to perform the job.<ul><li>Must possess a valid nursing license (Registered or Practical/Vocational). LPN orRN PREFERRED. </li><li>Minimum of 3-5 years as a pre-authorization or utilization review nurse in a payer or acute care setting; preferably medical-surgical or critical care/ED</li></ul>CERTIFICATES, LICENSES, REGISTRATIONS<ul><li>Current, valid RN/LPN/LVN licensure</li><li>Certified Professional in Utilization Review/Utilization Management/Healthcare Management (CPUR , CPUM, or CPHM) or Certified Case Manager (CCM) preferred </li></ul> 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.<ul><li>Ability to lift 15-20lbs </li><li>Ability to travel approximately 10% of the time; either to client &/or Conifer office sites</li><li>Ability to sit and work at a computer for a prolonged period of time conducting pre-service medical necessity reviews</li></ul>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.<ul><li>Characteristic of typical Call Center environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc.</li></ul>OTHER<ul><li>May require travel – approximately 10%</li><li>Interaction with staff at client facilities such as and not limited to Patient Access, Case management, physicians and/or their office staff is a requirement. </li></ul>
Employment practices will not be influenced or affected by an applicant’s or employee’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 participates in the E-Verify program. Follow the link below for additional information. 
E-Verify: <a href="http://www.uscis.gov/e-verify" rel="nofollow noopener noreferrer" target="_blank">http://www.uscis.gov/e-verify</a> 
The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations.

2603000569 Employment practices will not be influenced or affected by an applicant’s or employee’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.

Conifer Revenue Cycle Solutions

RC Pre-Authorization Clinician - THOP Memorial Campus

Tenet Healthcare Monster

Secures medical necessity checks/verification in accordance to Centers for Medicare & Medicaid services, verifies insurance, benefits, coverage & eligibility, completes assigned registration financial clearance work lists activities, obtains insurance authorizations for scheduled & unscheduled Hospital services, and secures inpatient visit notification to payors. Educates patients about patient financial liabilities, employs proper, compliant patient liability collection techniques before, during & after date of service, performs Hospital cash reconciliation & secured payment entry in adherence to financial & cash control policies & procedures.

<h3>Job Summary</h3>Spanish Bilingual RequiredSHIFT: Rotating Shifts Days, Evenings, Nights, WeekendsMUST be able to work all shifts. Will know schedule 5 weeks in advanceJOB SUMMARYResponsible for duties in support of departmental efficiencies which may include: but not limited to performing scheduling, registration, patient pre-admission and admission, reception and discharge functions. Must obtain complete and accurate patient demographic information. Patient Access representatives also must employ proper, compliant patient liability collection techniques before, during & after date of service.ESSENTIAL DUTIES AND RESPONSIBILITIESInclude the following. Others may be assigned.<ol><li>Greeting patients following Conifer Standards of Care, provides world-class customer service, completes full patient registration at date of service, adheres to financial & cash control policies & procedures, thoroughly explains and secures Hospital & patient legal forms (i.e., Advance Directives, Conditions of services, Consent for treatment, Important Message from Medicare, EMTALA, etc.). Scan Protected Health Information, create and file patient information packets/folders for upcoming Hospital services. May also assist with scheduling diagnostic procedures (enters data in scheduling system, provide customer with appointment instructions, other tasks as needed).</li><li>Educates patients about patient financial liabilities, employs proper, compliant patient liability collection techniques before, during & after date of service, performs Hospital cash reconciliation & secured payment entry in adherence to financial & cash control policies & procedures.</li><li>Secures medical necessity checks/verification in accordance to Centers for Medicare & Medicaid services, verifies insurance, benefits, coverage & eligibility, completes assigned registration financial clearance work lists activities, obtains insurance authorizations for scheduled & unscheduled Hospital services, and secures inpatient visit notification to payors. May also assist with scheduling and coordinating post discharge care for patients.</li></ol>KNOWLEDGE, SKILLS, ABILITIESTo 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.<ul><li>Minimum typing skills of 35 wpm</li><li>Demonstrated working knowledge of PC/CRT/printer</li><li>Knowledge of function and relationships within a hospital environment preferred</li><li>Customer service skills and experience </li><li>Ability to work in a fast paced environment </li><li>Ability to receive and express detailed information through oral and written communications</li><li>Understanding of Third Party Payor requirements preferred</li><li>Understanding of Compliance standards preferred</li><li>Must be able to perform essential job duties in at least two Patient Access service areas including Emergency Department.</li><li>Uses proper negotiation techniques to professionally collect money owed by our Patients/Guarantors.</li><li>Builds and maintains collaborative relationships with both internal and external Clients that lead to more effective communication and a higher level of productivity and accuracy. </li><li>Must be able to appropriately interpret physician orders, medical terminology and insurance cards while maintaining Conifer Standards of Care.</li></ul>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 / EXPERIENCEInclude minimum education, technical training, and/or experience preferred to perform the job.<ul><li>High School Diploma or GED required.</li><li>0 – 1 year in a Customer Service role. </li><li>0 – 1 year administrative experience in medical facility, health insurance, or related area preferred</li><li>Some college coursework is preferred </li></ul> 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.<ul><li>Must be able to sit at computer terminal for extended periods of time.</li><li>Resolves Physician's office and Patient issues. May experience extreme patient volumes and uncooperative Patients. </li><li>Occasionally lift/carry items weighing up to 25 lbs.</li><li>Frequent prolonged standing, sitting, and walking.</li><li>Occasionally push a wheelchair to assist patients with mobility problems.</li></ul>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.<ul><li>Hospital administration</li><li>Can work in patient care locations which include potential exposure to life-threatening patient conditions. </li></ul>OTHER<ul><li>Must be available to work hours and days as needed based on departmental/system demands.</li></ul>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!
Employment practices will not be influenced or affected by an applicant’s or employee’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 participates in the E-Verify program. Follow the link below for additional information. 
E-Verify: <a href="http://www.uscis.gov/e-verify" rel="nofollow noopener noreferrer" target="_blank">http://www.uscis.gov/e-verify</a> 
The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations.

2603006568 Employment practices will not be influenced or affected by an applicant’s or employee’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.

Campus Representative Jobs in El Paso, TX

Jobs

Similar Job Searches

Stand out to leading employers.

Campus Representative Jobs in El Paso, TX

Jobs

RC Pre-Authorization Clinician - THOP Memorial CampusConifer Revenue Cycle Solutions

Registrar ED - Rotating Shifts - THOP Sierra CampusConifer Revenue Cycle Solutions

Similar Job Searches