Description - External

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

Responsible for the review of accounts where the patient is covered under an Out of State Medicaid program to ensure all the appropriate enrollment forms are submitted in a timely and efficient manner.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Review and work the MEPRVWOOS delegation control ID, and desks in the following branches 70, 71, 72, ,73 ,74, 75, 77, 78 and 79.
• Thoroughly verify coverage for patients that present Medicaid from states other than the state in which they are receiving care.
• Perform follow-up on submitted enrollment applications within 20-30 days on status. (timelines dependent on state)
• Dispute and or appeal any enrollment applications that have been unjustly denied.
• Maintain a list of OOS application requirements and enrollment activity logs.
• Request updated W9, JACHO, CLIA License, etc from key contacts as needed.
• Completes re-certifications and revalidation to maintain provider credentials active

Qualifications - External

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

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.

• Working familiarity with the rules and regulations pertaining to Federal, State and County programs
• P/C systems literate including Windows, and Micorsoft Outlook, Excel and Word programs
• Ability to work independently
• Excellent oral and written communication skills, as well as the clear understanding of the English language
• Detail oriented, with strengths in dealing with multiple facilites, Supervisors, and Hospital platforms
• Ability to prioritize and manage multiple tasks with efficiency
• Valid Drivers License and auto insurance
• Other duties as assigned

EDUCATION / EXPERIENCE

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

• High School diploma or equivlent
• 2-3 experience in hospital/facility office provider credentialing 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 sitting position, use computer and answer telephone
• Specific vision abilities required by this job include close vision.

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

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.