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!
This role will be responsible in overseeing, planning, developing, implementing and maintaining Claims Administration functions and related processes. Ensure claims are processed accurately and timely for reimbursement to the Health Plan Providers and Clients, within Conifer, in accordance with contracted fee schedules and covered benefits as specified in the member evidence of coverage. The Director will actively collaborate with peers towards cross-departmental initiatives and fulfillment of the claims department strategic objectives.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Develops and implements policies and procedures to govern the delivery of claims services
Identifies areas for organization growth and delivers staff forecasting data to the Sr. Director for approval
In conjunction with the Sr. Director assures the department is in compliance with government contracts set in place by directing initiatives with management staff.
Directs managers and supervisors through coaching and motivating, professional development, work allocation, problem resolution, performance evaluation, and related supervisory activities to integratetheConifervisionandmissionintotheirpracticeofclaimsmanagement.
Oversee day to day operations and ensures department areas optimize workflow efficiencies to meet company objectives.
Provides supervision, guidance and mentoring to managers and staff.
Ability to work with internal customers to facilitate programs.
Represents the department to and takes direction from Executives as necessary.
Tracks trends, makes decisions based on organized information, and supports decisions with articulate written and verbal communications. Assist in creating annual budget and is responsible for the budget oversight of department. Provides business justification for capital and resource needs.
KNOWLEDGE, SKILLS, ABILITIES
Comprehensive knowledge of claims management, HIPAA standards, CMS requirements, managed care, CPT, and HCPS coding)
Abilitytomakelogicalandobjectivedecisions and affect change in others.
EDUCATION / EXPERIENCE
Bachelorï¿½s Degree or the equivalent combination of training and experience is required.
Must have at least 3-5 years of Managerial level experience
7 + years of progressively responsible experience in managed care or commercial insurance
Must be able to work in sitting position, answer telephone, and retrieve/use use computer as position requires extensive use of computer
Ability to adhere to attendance policy as position requires consistent onsite attendance.
Office Work Environment
Occasional to no traveling
Job: Conifer Health Solutions
Primary Location: Encino, California
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: 2005014734
About Tenet Healthcare
“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.