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6,016 nursing jobs and nurse industry jobs - July 25, 2017
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 Denials Specialist - Boca Raton, Florida    
 Job Number tenetnurse0313_3130    
 Job Type
 Job Category Nursing
 Company Tenet Healthcare Corporation-Nursing & Therapy
 Location Boca Raton, FL
 Salary Competitive
 Date Posted 07/13/2017
 Start Date Immediately
 Travel
*** View all Tenet Healthcare Corporation-Nursing & Therapy jobs ***


 Job Description

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 Specialist

 

JOB SUMMARY

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.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES

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.



Qualifications:

KNOWLEDGE, SKILLS, ABILITIES

To perform 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.

 

  • 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.

 

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

 

  • High School Diploma or equivalent, some college coursework preferred
  • 3 - 5 years’ experience in a hospital business environment performing billing and/or collections

 

PHYSICAL DEMANDS

The physical 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 time

 

WORK ENVIRONMENT

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

 

 

 

 MWW

Job:   Appeals
Primary Location:   Boca Raton, Florida
Job Type:   Full-time
Shift Type:   40 Hour Week With Overtime

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 Contact Info/How To Apply
  Please mention that you heard about this job on RxCareer Center when applying.  
   
   Login To Apply   Click Here To Login  
 Contact Name   Human Resources
 Web Address   https://jobs.tenethealth.com/job/-/ ...


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