As a part of the Tenet and
Catholic Health Initiatives family, Conifer Health Solutions is a leading
healthcare business process management services provider working to improve
operational performance for more than 600 clients so they can support financial
improvement, enhance the patient experience, and drive value-based performance.
Through our revenue cycle
management, patient communications,
and value-based care
solutions, we empower healthcare decision makers—hospitals, health systems,
physicians, self-insured employers, and payers—to better connect every point of
care and wellness management. Are you ready to be part of our
solutions? 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!
Conifer Health Solutions is currently hiring for a Denials
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
ESSENTIAL DUTIES AND
Include the following. Others may
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
- Generate an
appeal based on the dispute reason and contract terms specific to the payor.
This includes online reconsiderations.
specific payer guidelines for appeals submission.
exhausted appeal efforts for resolution.
- Work payer
projects as directed.
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.
research and makes determination of corrective actions and takes appropriate
steps to code the DCM system and route account appropriately.
denial or payment variance trends to NIC leadership team for payor escalation.
this job successfully, an individual must be able to perform each essential
duty satisfactorily. The requirements listed below are representative of the knowledge,
skill and/or ability required. Reasonable accommodations may be made to enable
individuals with disabilities to perform the essential functions.
understanding of Explanation of Benefits form (EOB), Managed Care Contracts,
Contract Language and Federal and State Requirements
knowledge of hospital billing form requirements (UB-04)
understanding of ICD-9, HCPCS/CPT coding and medical terminology
Microsoft Office (Word, Excel) skills
- Advanced business
letter writing skills to include correct use of grammar and punctuation.
Include minimum education,
technical training, and/or experience preferred to perform the job.
School Diploma or equivalent, some college coursework preferred
- 5 years’ experience in a hospital business environment performing billing
demands described here are representative of those that must be met by an
employee to successfully perform the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities
to perform the essential functions.
- Ability to sit and work at a computer terminal for extended periods of
The work environment
characteristics described here are representative of those an employee
encounters while performing the essential functions of this job. Reasonable
accommodations may be made to enable individuals with disabilities to perform
the essential functions.
- Call Center environment with multiple workstations in close proximity
Boca Raton, Florida
40 Hour Week With Overtime