Location: California City
Posted on: January 26, 2023
Conifer requires its candidates, as applicable and as permitted
by law, to obtain and provide confirmation of all required
vaccinations and screenings prior to the start of employment
activity. This may include, but is not limited to, the COVID-19
vaccination, influenza vaccination, and/or any future required
vaccines and screenings.
Provides direction to the Claims Unit team while monitoring daily
workflows, examiner assignments and production, and ensuring
compliance with health plan and regulatory requirements.
Degree of Supervision:
This position reports to the Operations Director and requires
minimum degree of supervision to ensure tasks are appropriately
Job Duties and Essential Functions:
Responsible for compliance of all claims regardless of department
where the claim is pending.
Monitors inventory reports and assigns work queues based on
staffing and/or volume re-assess, identifies and distributes
unprocessed work to staff on a first-in first-out basis or other
Works collectively with all levels of management and staff to
ensure compliance with inventory production and timeliness
standards including but not limited to QC, T&C, Eligibility,
UM, Compliance, and Operations Departments.
Reviews daily operational reports throughout the day to assure
Maintains controls to ensure that all claims are processed within
Reviews daily production reports to monitor and counsel staff not
meeting the established production requirements.
Reviews monthly report cards to train and counsel staff that is
consistently not meeting quality standards.
Identifies training for staff failing to meet established minimum
production and quality objectives.
Updates and implements department training materials, approved
policies and procedures, and such other approved reference
materials as may be required for performance of the examiner's job
Holds regular unit meetings to review new policies and procedures
and training issues.
Completes Corrective Action Plans for the Claims department by the
requested due dates.
Maintains and keeps in total confidence, all files, documents and
records that pertain to the operation of the business.
Attends internal and external meetings/trainings as necessary.
Manages staff hours and attendance
Assesses inventory vs. resources and provides overtime and
inventory reduction plans when necessary
Available to work extended hours and weekends.
Conifer requires its candidates, as applicable and as permitted by
law, to obtain and provide confirmation of all required
vaccinations and screenings prior to the start of employment. This
may include, but is not limited to, the COVID-19 vaccination,
influenza vaccination, and/or any future required vaccines and
High school diploma is required.
Over 4 years experience in processing managed care health
Must have good understanding of various coding concepts (ICD9 CM,
HCPCS, CPT , ASC, etc.).
Requires a working knowledge of managed care concepts and
regulatory requirements, particularly as relates to timeliness.
Must have keyboarding skills and ability to read and write English.
Must be able to assess work volumes versus resources.
Needs to be able to communicate in a clear and concise manner.
Needs basic understanding of word processing and spreadsheet
applications; Microsoft Office experience is preferred.
Must have keyboarding skills.
Must have strong written and verbal communication skills.
Must possess problem solving abilities and the ability to
multi-task in a demanding environment.
Light physical effort (lift up to 10lbs). Mostly sedentary work.
Regularly needs to be able to bend, stoop and reach to file.
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.
Keywords: Careerbuilder-US, Lancaster , Claims Manager-Hybrid, Executive , California City, California
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