Terms & Conditions Supervisor

Conifer Health Solutions

37d

About The Position

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.

Requirements

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 managed care/government contract interpretation skills
Strong analytical abilities
Minimum 1 year contract interpretation experience required
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
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.

Nice To Haves

Advanced knowledge of query writing applications a plus
Bachelor or Associate Degree preferred

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.

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.

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