Denials Senior Specialist

Description

JOB SUMMARY

Responsible for providing direct support to internal and subcontracted external legal resources engaged in the collection and recovery of managed care and/or Worker’s Compensation claims.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Acts as liaison between the Business Office, Legal Department and outside counsel regarding outstanding litigation (ie.Venders)
• Coordinates legal analysis for denied, underpaid and unpaid managed care accounts for legal referral; Compiles records and documentation for internal and external attorneys such as process documentation, copies of original contracts, etc to be used in litigation.
• Reviews all existing documentation including but not limited to UB, IB, Explanation of Benefits (EOB), and Managed Care Contracts to verify claim balance calculation; ensures integrity in supporting documentation.
• Works with Legal Department to file bankruptcy notifications on payers. May file liens on auto accident patients to state interest in claim.
• Verifies in system that accounts have been adjudicated correctly once settled. If needed, adjust accounts per Legal request.
• Works required reports (daily, weekly, monthly) to ensure legal payer issues are referred in a timely manner.

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.

• Intermediate writing skills
• Intermediate Microsoft Word and Excel skills
• Intermediate analytical and math skills
• Ability to coordinate accounts and record detailed information
• Ability to research and work independently
• Ability to work in high volume environment at a fast pace
• Ability to communicate in a professional manner

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 screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• High school diploma or equivalent
• Some college helpful
• 3-5 years experience in medical billing, collections, appeals, legal department and/or contract interpretation

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to sit at a computer terminal for extended periods of time

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Call-center environment with multiple workstations in close proximity

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!

Compensation and Benefit Information

Compensation

• Pay: $20.51 - $30.77 per hour. Compensation depends on location, qualifications, and experience.
• Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
• Conifer observed holidays receive time and a half.

Benefits

Conifer offers the following benefits, subject to employment status:

• Medical, dental, vision, disability, and life insurance
• Paid time off (vacation & sick leave) – min of 12 days per year, 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.