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!
Responsible for conducting audits to measure Quality Assurance across critical business processes. Complete analytical assessment of work product and processes to identify root cause of incidences and provide feedback to key stakeholders. Prepare reports to communicate QA results and findings to Leadership Team and process owners across the organization, driving accountability and ongoing improvement of QA metrics. Interface with internal customers to act as a functional and operational liaison for the end user group community. Understand policies and procedures and utilize them for daily Quality Assurance duties. Use The QA analyst will be responsible for documenting, and monitoring business processes and associated workflow.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Complete quality assurance inspections as required, ensuring standardization and compliance with established policies and procedures and applicable regulations.
Identify, research and document process improvement opportunities. Then collaborate with internal and external business partners (Operations, Compliance, Facilities, Payers) to drive accountability and process improvements
Prepare and review data and QA reporting with key stakeholders.
Provide input for policies and procedures updates as required.
Special projects as assigned
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.
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The Ability to complete the review of a clinical appeal letter using critical thinking skills and practical application of national criteria guidelines, InterQualÂ® (IQ) and MillimanÂ® (MCG) evidenced based medicine.
The ability to evaluate the appeal letter when the national criteria guidelines are â��not metâ��. This criterion includes co-morbid conditions, the patient age, and the medical predictability of an adverse outcome if the patient is not cared for in the appropriate level of care.
Must possess a clear knowledge of all clinical activity codes and their practical application to differing dispute scenarios.
The QA nurse analyst must have a clear understanding of the clinical dispute process, how to review a disputed account in ACE, the client specific Case Management application, the correspondence application, the EMR and any other associated applications such as N-thrive..
Must have a solid knowledge of patientâ��s across the
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.
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.