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.
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/ Health Savings Account**
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? ï¿½ Apply today! We are interviewing soon!
Job: Conifer Health Solutions
Primary Location: Texas
Job Type: Full-time
Shift Type: Days
If Other Shift, Specify: Full-time day shifts
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Internal Number: 2005019389
About Conifer Health Solutions
“Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans.