We are a community built on care. Our caregivers and supporting staff extend compassion to those in need, helping to improve the health and well-being of those we serve, and provide comfort and healing. Your community is our community. We started out as a small operation in California. In May 1969, we acquired four hospitals, some additional care facilities and real estate for the future development of hospitals. Over the years, we've grown tremendously in size, scope and capability, building a home in new markets over time, and curating those homes to provide a compassionate environment for those entrusting us with their care. Today, we are a leading health system and services platform that continues to evolve in lockstep with community need. Tenet's operations include three businesses - our hospitals and physicians, USPI and Conifer Health Solutions. Our impact spreads far and deep with 65 hospitals and approximately 510 outpatient centers and additional sites of care. We are differentiated by our top-notch medical specialists and service lines that are tailored within each community we serve. Together as an enterprise, we work to save lives and can accept nothing less than excellence from ourselves in service of our patients and their families, every day. Careers at Tenet At Tenet Healthcare, the heart of what we do centers on caring with compassion, which ultimately creates a bond between our caregivers and patients. Everyone contributes to these moments, whether providing care directly or supporting those who do. As an organization, we provide employees with resources, tools and support to serve our patients and customers in the best way possible. We also take care of one another, helping team members further develop their career pathways and maximize their potential.
Hospital Denials Specialist
Location
United States
Posted
12 days ago
Salary
Not specified
No structured requirement data.
Job Description
Role Description
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.
- Validate denial reasons and ensure 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, including online reconsiderations.
- Follow specific payer guidelines for appeals submission.
- Escalate exhausted appeal efforts for resolution.
- Work on payer projects as directed.
- Research contract terms/interpretation and compile necessary supporting documentation for appeals.
- Address Terms & Conditions for Internet enabled Managed Care System (IMaCS) adjudication issues and refer to refund unit on overpayments.
- Perform research and make determination of corrective actions, taking 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
- High School Diploma or equivalent, some college coursework preferred.
- 3 - 5 years experience in a hospital business environment performing billing and/or collections.
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.
Physical Demands
- Ability to sit and work at a computer terminal for extended periods of time.
Work Environment
- Call Center environment with multiple workstations in close proximity.
Benefits
- Medical, dental, vision, disability, and life insurance.
- Paid time off (vacation & sick leave) – minimum of 12 days per year, accruing 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.
Compensation
- Pay: $18.60 - $28.00 per hour. Compensation depends on location, qualifications, and experience.
- Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
- Conifer observed holidays receive time and a half.
Job Requirements
- High School Diploma or equivalent, some college coursework preferred.
- 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.
- 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.
- Physical Demands
- Ability to sit and work at a computer terminal for extended periods of time.
- Work Environment
- Call Center environment with multiple workstations in close proximity.
Benefits
- Medical, dental, vision, disability, and life insurance.
- Paid time off (vacation & sick leave) – minimum of 12 days per year, accruing 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.
- Compensation
- Pay: $18.60 - $28.00 per hour. Compensation depends on location, qualifications, and experience.
- Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
- Conifer observed holidays receive time and a half.
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