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Denials Specialist - Remote

  • Job ID 2005031646
  • Date posted 09/23/2020
  • Facility Conifer Health Solutions

We are actively seeking a DENIALS SPECIALIST to join the Conifer Health Solutions team!

The Denials Specialist is responsible for validating dispute reasons following Explanation of Benefits (EOB) review, escalating payment variance trends or issues to NIC management, and generating appeals for denied or underpaid claims.

What You'll Do
Include the following. Others may be assigned.
-Validate denial reasons and ensures coding in DCM is accurate and reflects the denial reasons. Coordinate with the Clinical Resource Center (CRC) for clinical consultations or account referrals when necessary,
-Generate an appeal based on the dispute reason and contract terms specific to the payor. This includes online reconsiderations.
-Follow specific payer guidelines for appeals submission
-Escalate exhausted appeal efforts for resolution
-Work payer projects as directed
-Research contract terms/interpretation and compile necessary supporting documentation for appeals, Terms & Conditions for Internet enabled Managed Care System (IMaCS) adjudication issues, and referral to refund unit on overpayments.
-Perform research and makes determination of corrective actions and takes appropriate steps to code the DCM system and route account appropriately.
-Escalate denial or payment variance trends to NIC leadership team for payor escalation.

What You Bring to the Team
-Intermediate understanding of Explanation of Benefits form (EOB), Managed Care Contracts, Contract Language and Federal and State Requirements
-Intermediate knowledge of hospital billing form requirements (UB-04)
-Intermediate understanding of ICD-9, HCPCS/CPT coding and medical terminology
-Intermediate Microsoft Office (Word, Excel) skills
-Advanced business letter writing skills to include correct use of grammar and punctuation.

What You Will Need to be Successful
-High School Diploma or equivalent, some college coursework preferred
-3 - 5 years of experience in a hospital business environment performing billing and/or collections
-Ability to work from home (dedicated workspace and internet access)

What We Offer
At Conifer Health Solutions, we truly value our people. That's why we offer a benefits package that is more than competitive. From your health and well-being to your long-term financial security, we're as committed to your future as you are.
-Competitive wages
-Opportunities to better yourself professionally
-Health, Dental & Vision Coverage**
-401(k) retirement plan**
-Paid Time Off (PTO)**
-Company Paid Holidays**
-Employee perks and discount programs
-Employee Assistance Programs**
-Flexible Spending Account**
-Education Assistance
-Short Term Disability and Long Term Disability Insurance**
**Available for full-time, regular employees of Conifer Health Solutions after meeting certain eligibility requirements

Who We Are
At Conifer Health Solutions, we are passionate about providing the foundation for better health. 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. 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!

For more information about Conifer Health, check out our website, Facebook, Twitter, or LinkedIn.

Are you ready to be part of our solutions? Apply today! We are interviewing soon!



Job: Conifer Health Solutions
Primary Location: Frisco, Texas
Job Type: Full-time
Shift Type: Days