Denials Specialist – Remote Full Time NEW

Summary:

Conifer Revenue Cycle Solutions, part of the Tenet and Catholic Health Initiatives family, offers the Denials Specialist – Remote role. With 30 years of healthcare expertise, Conifer serves clients in over 135 regions nationwide, helping strengthen financial and clinical performance. The company supports transitions to value-based care, enhances patient experiences, and improves healthcare quality, cost, and access.

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.
• 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.

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.
• Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment.
• 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.

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.
• Conifer observed holidays receive time and a half.
• Position may be eligible for a signing bonus for qualified new hires, subject to employment status.