As a part of the Tenet and Catholic Health Initiatives family, Conifer Health Solutions is a leading healthcare business process management services provider working to improve operational performance for more than 600 clients so they can support financial improvement, enhance the patient experience, and drive value-based performance. Through our revenue cycle management, patient communications, and value-based care solutions, we empower healthcare decision makers€”hospitals, health systems, physicians, self-insured employers, and payers€”to better connect every point of care and wellness management. 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!
Our mission is to "improve Healthcare by increasing Healthcare quality and cost control through the effective deployment of information management and transaction efficiency.’"
Our vision is to provide "Global Support for Local Health Care." By following the principles of mutual respect for patients and families, our Nurses work with participants, providers, employers, health systems and hospitals, payers, professional advisors and communities to identify and coordinate the most appropriate services to address their healthcare needs.
As a technology based company, we have developed a comprehensive, fully integrated, URAC certified web-based medical management software application that combines Conifer€™s web-based data warehouse and reporting platform with a robust medical management software and workflow system. The result is a seamless and comprehensive database, management and reporting tool that support all levels of medical management interventions; utilization management, case management, and disease management. Our nurses find this application to be a very efficient, easy to navigate and helpful tool as it is integrated with documentation and research materials.
Conifer Health Solutions is currently hiring for a Claims Adjuster Specialist.
Responsible for the accurate and timely adjudication of all claims in accordance with applicable contracts, state and federal regulations, health plan requirements, policies and procedures, and generally accepted business practices.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
€¢ Reviews providers€™ disputes and appeals, for professional and hospital claims, to determine resolution according to policies and procedures. Adheres to state and federal policies and procedures when adjudicating claims, including but not limited to, interest calculation and resolution timeliness
€¢ Perform any projects delegated by claims supervisor.
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.
‚§ General office equipment experience (i.e. photocopier, fax, calculator, ability to operate a PC and previous exposure to the Microsoft Windows environment).
‚§ Must have an excellent understanding of health and managed care concepts and their application in the adjudication of claims.
‚§ Strong working knowledge of ICD.9.CM, CPT, HCPCS, RBRVS coding schemes and medical terminology.
EDUCATION / EXPERIENCE
‚§ High School Diploma or Equivalent preferred
‚§ 3-5 years of claims examiner experience preferred
‚§ Minimum of one year experience handling provider disputes/appeals preferably in a PPO, self-funded, and/or HMO setting preferred
Job: Conifer Health SolutionsPrimary Location: Encino, CaliforniaHospital Location: Conifer Value Based CareJob Type: Full-timeShift Type: Days
Qualifications: 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.
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