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!
Conifer Health Solutions is currently hiring for a full time Provider Network Rep. This position will work Monday through Friday from 8:00am until 5:00pm at our Central Valley Medical Providers office in Fresno, CA. Prior experience in healthcare is required. Provider relations experience a huge plus!
The Provider Network Coordinator serves as a liaison between Conifer, contracted physicians, contracted hospital, and health plans. The Provider Network Coordinator handles and/or fields IPA operational issues. Prepares and maintains Provider Network corporate documentation. Ensures accuracy of Provider Network provider listings and coordinates provider changes with health plans.
ESSENTIAL DUTIES AND RESPONSIBILITIESinclude the following. Other duties may be assigned.
Documents, tracks, and closes provider issues in the Customer Service Module that are received by mail, phone, fax, or from internal staff.
Answers and fields incoming Network Management Department calls, including the ACD, and individual phone lines.
Reviews the LOU worklist daily and does the necessary internal & external research, contacts appropriate provider and facilitates terms and conditions consistent with the LOU negotiation policy.
Ensures accuracy of physician demographic information and tracks returned correspondence and routes necessary changes to the Credentialing and Terms and Conditions Department through the Customer Service Module in a timely manner.
Ensures and notifies health plans of provider contract status changes and handles the administrative component of the listings.
Reviews the provider credentialing listing and non-compliant provider reports generated from the Credentialing Department to ensure that provider information is prepared and ready to present to the IPA Board of Directors binders. Generates and circulates IPA rosters to internal departments, contracted providers, and health plans on a regular basis as necessary.
Reviews the provider listing reports on a regular basis and works with the Credentialing Department to ensure that provider information is submitted to the health plans and provider numbers are obtained for contracted physicians.
Distributes the Network Management materials to internal departments, contracted providers, and health plans, such as, newsletters, health plan information, educational information, surveys, and other provider communications on a regular basis and as necessary.
Coordinates monthly IPA Board of Director, UM, and QI Committee meetings, sends reminder notices, and notifies internal staff, physicians, and other attendees as assigned.
Prepares and gathers all data necessary for the monthly IPA Board of Director, UM, and QI Committee binders, as assigned.
Prepares and disseminates monthly IPA Board of Director, UM, and QI Committee meeting minutes, as assigned.
Attends monthly IPA Board of Director, UM, and QI Committee meetings, as assigned to provide record keeping.
Works well with coworkers and is a good team player. Interacts effectively with internal departments. Recommends improvements to operational process to improve overall provider satisfaction.
Maintains and keeps in total confidence, all files, documents and records that pertain to the operation of business of Cap Management Systems.
All other job related duties as it relates to the job function or as delegated by the management team.
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.
Minimum of 2 years of experience in Managed Care, specifically with contracting, credentialing and customer service experience required. Knowledge of HMO Insurance (Commercial, Senior & Medi-Cal). Familiar with NCQA Credentialing guidelines. Ability to work with a diverse group of people/disciplines at all levels of an organization.
Must be able to work in a fast-paced environment and adapt to changing situations.
Ability to demonstrate an appropriate level of assertiveness in performing responsibilities and in making decisions required. Excellent verbal and written communication skills.
Proficient experience with Microsoft Office programs required and database experience/education a plus.
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
Bachelorï¿½s Degree or equivalent
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.
Light physical effort (lift up to 10 lbs.). Mostly sedentary work. Regularly needs to be able to bend, stoop and reach to file.
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/Team Work Environment
Job: Conifer Health Solutions
Primary Location: Frisco, Texas
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��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.
Internal Number: 1905046333
About Conifer Health Solutions
“Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans.