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Conifer Health Solutions · 2 weeks ago

Remote- AR Denials Specialist

United States

Full-time

Remote

Mid Level

$18.60/hr - $28/hr

3+ years exp

Conifer Health Solutions is a healthcare company that specializes in improving financial and clinical performance for healthcare organizations. They are seeking an AR Denials Specialist who will be responsible for validating dispute reasons, generating appeals for denied claims, and escalating payment variance trends to management.

Health Care

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

Qualification

EOB understandingManaged Care ContractsICD-9 codingHospital billing (UB-04)Microsoft OfficeBusiness letter writingMedical terminologySoft skills

Required

High School Diploma or equivalent

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 to include correct use of grammar and punctuation

Ability to sit and work at a computer terminal for extended periods of time

Preferred

Some college coursework preferred

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.