Denials Specialist-Remote
About The Position
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. 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!
Requirements
- 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.
- High School Diploma or equivalent, some college coursework preferred
- 3 - 5 years experience in a hospital business environment performing billing and/or collections
- Ability to sit and work at a computer terminal for extended periods of time
Responsibilities
- 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.
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
Entry Level
Industry
Hospitals
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
