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Conifer Health Solutions · 2 hours ago

Denials Senior Specialist-Remote

United States

Full-time

Remote

Mid, Senior Level

$20.51/hr - $30.77/hr

3+ years exp

Conifer Health Solutions is a healthcare company that provides expertise in financial and clinical performance. The Denials Senior Specialist is responsible for supporting legal resources in the collection and recovery of managed care and Worker’s Compensation claims, ensuring proper documentation and communication between departments.

Health Care

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

Qualification

Medical billing experienceLegal department experienceContract interpretationMicrosoft WordMicrosoft ExcelAnalytical skillsResearch skillsProfessional communicationWriting skillsDetail-oriented

Required

High school diploma or equivalent

3-5 years experience in medical billing, collections, appeals, legal department and/or contract interpretation

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

Preferred

Some college helpful

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.