5 Revenue Cycle Precert Clinician Jobs in El Paso, TX
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Revenue Cycle Precert Clinician
$69k-86k (estimate)
Full Time | Business Services
3 Days Ago
Conifer Health Solutions is Hiring a Revenue Cycle Precert Clinician Near El Paso, TX
Job SummaryThe Revenue Cycle Management Clinician for the Pre-Authorization Solution is responsible for:
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.
- 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).
- Coordinating with ordering physicians and/or facility staff to secure the necessary prior payment authorization utilizing applicable payer criteria.
- 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.
- 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.
- Demonstrates proficiency in the use of multiple electronic tools required by both Conifer and its clients.
- 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.
- Other duties as assigned
- Ability to work independently and self-regulate in compliance with deadlines
- Proficiency in the application of applicable nationally and payer authorization criteria
- Possesses excellent customer service skills that include written and verbal communication.
- Minimum Intermediate Microsoft Office (Excel and Word) skill
- Ability to critically think, problem solve and make independent decisions
- Ability to interact intelligently and professionally with other clinical and non-clinical partners
- Ability to prioritize and manage multiple tasks with efficiency
- Advanced conflict resolution skills
- Ability to communicate effectively at all levels
- Ability to conduct research regarding payer pre-authorization guidelines and applicable regulatory processes related to the pre-authorization process
- Must possess a valid nursing license (Registered or Practical/Vocational). LPN or RN PREFERRED.
- 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
- Current, valid RN/LPN/LVN licensure
- Certified Professional in Utilization Review/Utilization Management/Healthcare Management (CPUR , CPUM, or CPHM) or Certified Case Manager (CCM) preferred
- Ability to lift 15-20lbs
- Ability to travel approximately 10% of the time; either to client &/or Conifer office sites
- Ability to sit and work at a computer for a prolonged period of time conducting pre-service medical necessity reviews
- Characteristic of typical Call Center environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc.
- May require travel – approximately 10%
- 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.
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.
Job Summary
JOB TYPE
Full Time
INDUSTRY
Business Services
SALARY
$69k-86k (estimate)
POST DATE
06/24/2024
EXPIRATION DATE
07/22/2024
WEBSITE
coniferhealth.com
HEADQUARTERS
KATY, TX
SIZE
7,500 - 15,000
FOUNDED
2008
TYPE
Private
CEO
REGINALD MCCALL
REVENUE
$1B - $3B
INDUSTRY
Business Services
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About Conifer Health Solutions
Conifer Health is a healthcare services firm that provides consumer experience, risk and revenue cycle management solutions for businesses.
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