Medicare Denials Specialist - Remote

Conifer Revenue Cycle Solutions • Frisco, TX

124d • $18 - $28 • Remote

About The Position

The position 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. The role includes validating denial reasons, ensuring accurate coding in DCM, coordinating with the Clinical Resource Center for consultations, generating appeals based on dispute reasons, and following payer guidelines for submission. The individual will also perform research on contract terms, compile documentation for appeals, and escalate denial trends to leadership.

Requirements

• High School Diploma or equivalent, some college coursework preferred.
• 3 - 5 years experience in a hospital business environment performing billing and/or collections.
• 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.

Responsibilities

• Validate denial reasons and ensure coding in DCM is accurate.
• Coordinate with the Clinical Resource Center for clinical consultations or account referrals.
• Generate an appeal based on the dispute reason and contract terms specific to the payor.
• Follow specific payer guidelines for appeals submission.
• Escalate exhausted appeal efforts for resolution.
• Work on payer projects as directed.
• Research contract terms/interpretation and compile necessary supporting documentation for appeals.
• Perform research and make determinations of corrective actions.
• Escalate denial or payment variance trends to NIC leadership team.

Benefits

• Medical, dental, vision, disability, and life insurance.
• Paid time off (vacation & sick leave) - minimum of 12 days per year.
• 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 including pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• Paid leave in accordance with Colorado's Healthy Families and Workplaces Act for Colorado employees.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED