Denials Senior Specialist - Remote
About The Position
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. 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!
Requirements
- 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
- High school diploma or equivalent
- 3-5 years experience in medical billing, collections, appeals, legal department and/or contract interpretation
Nice To Haves
- Some college helpful
Responsibilities
- 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.
Benefits
- 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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
