Conifer Health Solutions
Terms & Conditions Supervisor- Remote
Conifer Health Solutions, Frisco, Texas, United States, 75034
Job Summary
Terms and Conditions supervisor is responsible for healthcare insurance reimbursement analysis; validating pre-load and post-load of contracts; applying independent judgment in the maintenance of the claims adjudication system; formulating and implementing system improvements, acting as a subject matter expert during contract negotiation processes, making recommendations to the Managed Care negotiators regarding terms of the contract; and collaborating with key stakeholders for the resolution of related issues. This role is also responsible for daily production and exception detail processing reports, collaborating with key stakeholders for the resolution and feedback of related issues. This role is also responsible for the monitoring of productivity, quality and performance of Contract Coordinators and Contract Analyst.
Responsibilities
Formulates and implements amendments and changes for contract loads, as a part of the client audit process, deviating from established procedures as necessary, within approved guidelines.
Regularly exercises discretion in analyzing and identifying issues associated with reprice impact reports after communication log issue have been corrected and re‑priced. Formulates and implements solutions to identified issues and is empowered to make exceptions when required to move issues to resolution. Independently audits and verifies post‑contract changes.
Collaborates with Client Managed Care and adjudication software Account Rep to ensure contract profiles are pricing accurately, per contract language. Communicates with appropriate leadership to ensure discrepancies are resolved prior to close of month end. Escalates payer issues to applicable business units, clients and leadership. Attends regular meetings with Client Managed Care, Conifer business units and adjudication vendor.
Reviews internal requests for assistance and executes work list/queries for newly opened communication logs. Documents affected accounts as required.
Identifies alternative opportunities in contract interpretation and revenue routing through the analysis of issues and, acting as a subject matter expert, provides alternative recommendations to management and staff. Activation of Plan id’s in mainframe system and adjudication software complying with NIC standards.
Monitors the completion of daily processing reports, daily payor change reports and daily account research from worklist reports and reviews for improperly adjudicated accounts.
Works other weekly, bi‑monthly and month end reporting queries and reviews for improperly adjudicated accounts. Works aging reports and assists in explaining variances in cash and aging performance.
Completes quality assurance reviews via Witness on impacted staff. Monitors productivity and provides feedback on employee performance. Monitors staff time and attendance and completes employee performance management as required. Provides scenario specific training and next step direction to staff.
Knowledge, Skills, and Abilities
This position requires knowledge of and the ability to perform all functions of the Contract Analyst.
Advanced understanding of hospital billing form requirements (UB-04)
Advanced understanding of ICD-9, HCPCS/CPT coding and medical terminology
Advanced Microsoft Office (Word, Excel)
Advanced knowledge of query writing applications a plus
Advanced managed care/government contract interpretation skills
Strong analytical abilities
Education / Experience
Minimum 1 year contract interpretation experience required
Bachelor or Associate Degree preferred
3-5 years of relevant hospital business office experience preferred
Must be able to implement a systematic, self‑motivated approach to problem solving and be able to identify, coordinate and optimize resources needed to execute plans
Physical Demands
Must be able to work in sitting position, use computer and answer telephone
Includes ability to walk through hospital‑based departments across broad campus settings, including Emergency Department environments
Ability to lift and/or move up to 25 pounds
Specific vision abilities required by this job include close vision.
Ability to travel
Work Environment
Office Work Environment
Hospital Work Environment
Other
Other duties as assigned
Compensation and Benefit Information
Pay: $64,168-$96,262 annually. Compensation depends on location, qualifications, and experience.
Management level positions may be eligible for sign‑on and relocation bonuses.
Benefits
Medical, dental, vision, disability, life, and business travel insurance
Paid time off (vacation & sick leave) – min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked.
401k with up to 6% employer match
10 paid holidays per year
Health savings accounts, healthcare & dependent flexible spending accounts
Employee Assistance program, Employee discount program
Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.
Seniority Level
Executive
Employment Type
Full‑time
Job Function
Other
Industries
Hospitals and Health Care and Medical Practices
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.
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Responsibilities
Formulates and implements amendments and changes for contract loads, as a part of the client audit process, deviating from established procedures as necessary, within approved guidelines.
Regularly exercises discretion in analyzing and identifying issues associated with reprice impact reports after communication log issue have been corrected and re‑priced. Formulates and implements solutions to identified issues and is empowered to make exceptions when required to move issues to resolution. Independently audits and verifies post‑contract changes.
Collaborates with Client Managed Care and adjudication software Account Rep to ensure contract profiles are pricing accurately, per contract language. Communicates with appropriate leadership to ensure discrepancies are resolved prior to close of month end. Escalates payer issues to applicable business units, clients and leadership. Attends regular meetings with Client Managed Care, Conifer business units and adjudication vendor.
Reviews internal requests for assistance and executes work list/queries for newly opened communication logs. Documents affected accounts as required.
Identifies alternative opportunities in contract interpretation and revenue routing through the analysis of issues and, acting as a subject matter expert, provides alternative recommendations to management and staff. Activation of Plan id’s in mainframe system and adjudication software complying with NIC standards.
Monitors the completion of daily processing reports, daily payor change reports and daily account research from worklist reports and reviews for improperly adjudicated accounts.
Works other weekly, bi‑monthly and month end reporting queries and reviews for improperly adjudicated accounts. Works aging reports and assists in explaining variances in cash and aging performance.
Completes quality assurance reviews via Witness on impacted staff. Monitors productivity and provides feedback on employee performance. Monitors staff time and attendance and completes employee performance management as required. Provides scenario specific training and next step direction to staff.
Knowledge, Skills, and Abilities
This position requires knowledge of and the ability to perform all functions of the Contract Analyst.
Advanced understanding of hospital billing form requirements (UB-04)
Advanced understanding of ICD-9, HCPCS/CPT coding and medical terminology
Advanced Microsoft Office (Word, Excel)
Advanced knowledge of query writing applications a plus
Advanced managed care/government contract interpretation skills
Strong analytical abilities
Education / Experience
Minimum 1 year contract interpretation experience required
Bachelor or Associate Degree preferred
3-5 years of relevant hospital business office experience preferred
Must be able to implement a systematic, self‑motivated approach to problem solving and be able to identify, coordinate and optimize resources needed to execute plans
Physical Demands
Must be able to work in sitting position, use computer and answer telephone
Includes ability to walk through hospital‑based departments across broad campus settings, including Emergency Department environments
Ability to lift and/or move up to 25 pounds
Specific vision abilities required by this job include close vision.
Ability to travel
Work Environment
Office Work Environment
Hospital Work Environment
Other
Other duties as assigned
Compensation and Benefit Information
Pay: $64,168-$96,262 annually. Compensation depends on location, qualifications, and experience.
Management level positions may be eligible for sign‑on and relocation bonuses.
Benefits
Medical, dental, vision, disability, life, and business travel insurance
Paid time off (vacation & sick leave) – min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked.
401k with up to 6% employer match
10 paid holidays per year
Health savings accounts, healthcare & dependent flexible spending accounts
Employee Assistance program, Employee discount program
Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.
Seniority Level
Executive
Employment Type
Full‑time
Job Function
Other
Industries
Hospitals and Health Care and Medical Practices
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.
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