{"id":18572,"date":"2024-06-27T06:00:12","date_gmt":"2024-06-27T06:00:12","guid":{"rendered":"https:\/\/exam4sure.com\/jobs\/?p=18572"},"modified":"2024-06-27T06:00:12","modified_gmt":"2024-06-27T06:00:12","slug":"denials-specialist-remote","status":"publish","type":"post","link":"https:\/\/exam4sure.com\/jobs\/denials-specialist-remote\/","title":{"rendered":"Denials Specialist &#8211; Remote"},"content":{"rendered":"<p><strong>JOB SUMMARY<\/strong><\/p>\n<p>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.<\/p>\n<h5><a href=\"https:\/\/joblagii.com\/company\/Tenet-Healthcare\">Denials Specialist &#8211; Remote<\/a><\/h5>\n<p><strong>ESSENTIAL DUTIES AND RESPONSIBILITIES<\/strong><\/p>\n<p><i>Include the following. Others may be assigned.<\/i><\/p>\n<ul>\n<li>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,<\/li>\n<li>Generate an appeal based on the dispute reason and contract terms specific to the payor. This includes online reconsiderations.<\/li>\n<li>Follow specific payer guidelines for appeals submission<\/li>\n<li>Escalate exhausted appeal efforts for resolution<\/li>\n<li>Work payer projects as directed<\/li>\n<li>Research contract terms\/interpretation and compile necessary supporting documentation for appeals, Terms &amp; Conditions for Internet enabled Managed Care System (IMaCS) adjudication issues, and referral to refund unit on overpayments.<\/li>\n<li>Perform research and makes determination of corrective actions and takes appropriate steps to code the DCM system and route account appropriately.<\/li>\n<li>Escalate denial or payment variance trends to NIC leadership team for payor escalation.<\/li>\n<\/ul>\n<h5><a href=\"https:\/\/joblagii.com\/company\/Tenet-Healthcare\">Denials Specialist &#8211; Remote<\/a><\/h5>\n<p><strong>KNOWLEDGE, SKILLS, ABILITIES<\/strong><\/p>\n<p><i>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.<\/i><\/p>\n<ul>\n<li>Intermediate understanding of Explanation of Benefits form (EOB), Managed Care Contracts, Contract Language and Federal and State Requirements<\/li>\n<li>Intermediate knowledge of hospital billing form requirements (UB-04)<\/li>\n<li>Intermediate understanding of ICD-10, HCPCS\/CPT coding and medical terminology<\/li>\n<li>Intermediate Microsoft Office (Word, Excel) skills<\/li>\n<li>Advanced business letter writing skills to include correct use of grammar and punctuation.<\/li>\n<\/ul>\n<p>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. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and\/or any future required vaccines and screenings.<\/p>\n<p>&nbsp;<\/p>\n<h5><a href=\"https:\/\/joblagii.com\/company\/Tenet-Healthcare\">Denials Specialist &#8211; Remote<\/a><\/h5>\n<p><strong>EDUCATION \/ EXPERIENCE<\/strong><\/p>\n<p><i>Include minimum education, technical training, and\/or experience preferred to perform the job.<\/i><\/p>\n<ul>\n<li>High School Diploma or equivalent, some college coursework preferred<\/li>\n<li>3 &#8211; 5 years experience in a hospital business environment performing billing and\/or collections<\/li>\n<\/ul>\n<p><strong>PHYSICAL DEMANDS<\/strong><\/p>\n<p><i>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.<\/i><\/p>\n<ul>\n<li>Ability to sit and work at a computer terminal for extended periods of time<\/li>\n<\/ul>\n<p><strong>WORK ENVIRONMENT<\/strong><\/p>\n<p><i>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.<\/i><\/p>\n<ul>\n<li>Call Center environment with multiple workstations in close proximity<\/li>\n<\/ul>\n<h5><a href=\"https:\/\/joblagii.com\/company\/Tenet-Healthcare\">Denials Specialist &#8211; Remote<\/a><\/h5>\n<p>As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. 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!<\/p>\n<p><strong>Compensation and Benefit Information<\/strong><\/p>\n<p><strong><u>Compensation<\/u><\/strong><\/p>\n<ul>\n<li>Pay: $17.20-$25.70 per hour. Compensation depends on location, qualifications, and experience.<\/li>\n<li>Position may be eligible for a signing bonus for qualified new hires, subject to employment status.<\/li>\n<li>Conifer observed holidays receive time and a half.<\/li>\n<\/ul>\n<p><strong><u>Benefits<\/u><\/strong><\/p>\n<p><strong>Conifer offers the following benefits, subject to employment status:<\/strong><\/p>\n<h5><a href=\"https:\/\/joblagii.com\/company\/Tenet-Healthcare\">Denials Specialist &#8211; Remote<\/a><\/h5>\n<ul>\n<li>Medical, dental, vision, disability, and life insurance<\/li>\n<li>Paid time off (vacation &amp; sick leave) \u2013 min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.<\/li>\n<li>401k with up to 6% employer match<\/li>\n<li>10 paid holidays per year<\/li>\n<li>Health savings accounts, healthcare &amp; dependent flexible spending accounts<\/li>\n<li>Employee Assistance program, Employee discount program<\/li>\n<li>Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder &amp; childcare, AD&amp;D, auto &amp; home insurance.<\/li>\n<li>For Colorado employees, Conifer offers paid leave in accordance with Colorado\u2019s Healthy Families and Workplaces Act.<\/li>\n<\/ul>\n<h3 style=\"text-align: center;\">Denials Specialist &#8211; Remote<\/h3>\n<p>&nbsp;<\/p>\n<h4>\u201cTop 10 Interview Questions\u201d<\/h4>\n<ul>\n<li>Can you tell us about yourself?<\/li>\n<li>What interests you about this position?<\/li>\n<li>What are your strengths?<\/li>\n<li>What are your weaknesses?<\/li>\n<li>Can you give an example of a time when you solved a problem creatively?<\/li>\n<li>How do you handle stress and pressure?<\/li>\n<li>How would you describe your work style?<\/li>\n<li>Can you tell us about a time when you had to work with a difficult<\/li>\n<li>colleague or supervisor?<\/li>\n<li>How do you stay organized and prioritize tasks?<\/li>\n<li>What are your long-term career goals?<\/li>\n<\/ul>\n<h4>Document Required:<\/h4>\n<ul>\n<li>Required Documents for This Recruitment: The candidate should have this Document Before Apply Online. Candidates Are Suggested To Read<\/li>\n<li>the Official Notification Before Applying.<\/li>\n<li>Document \u2013 Qualifications certificate with mark sheets.<\/li>\n<li>Passport size Photographs<\/li>\n<li>Signature<\/li>\n<\/ul>\n<h4>How to apply:<\/h4>\n<ul>\n<li>All the eligible candidates can apply for This Job as mentioned below<\/li>\n<li>Read the official notification carefully From the Official Website.<\/li>\n<li>Read the Notification Carefully Before Applying.<\/li>\n<li>Fill out The Application Form (The link Is Given Below)<\/li>\n<li>Attach the Required Document and Passport Size Photo with Signature.<\/li>\n<li>Then Submit. Done<\/li>\n<\/ul>\n<h3 class=\"sub-nav-cta__header\" style=\"text-align: center;\">Denials Specialist &#8211; Remote<\/h3>\n<p><a href=\"https:\/\/joblagii.com\/company\/Tenet-Healthcare\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-1841 aligncenter\" src=\"https:\/\/exam4sure.com\/jobs\/wp-content\/uploads\/2023\/12\/appy-300x116.jpg\" alt=\"\" width=\"300\" height=\"116\" \/><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>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. Denials Specialist &#8211; Remote ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. Validate denial reasons and ensures coding in DCM is accurate [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":1043,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,1261,108],"tags":[1262],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.2 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Denials Specialist - Remote<\/title>\n<meta name=\"description\" content=\"Denials Specialist - Remote , online remote jobs , online work from home jobs , remote job work from home , service online jobs\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/exam4sure.com\/jobs\/denials-specialist-remote\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Denials Specialist - Remote\" \/>\n<meta property=\"og:description\" content=\"Denials Specialist - Remote , online remote jobs , online work from home jobs , remote job work from home , service online jobs\" \/>\n<meta property=\"og:url\" content=\"https:\/\/exam4sure.com\/jobs\/denials-specialist-remote\/\" \/>\n<meta property=\"og:site_name\" content=\"Latest Remote Jobs in USA\" \/>\n<meta property=\"article:published_time\" content=\"2024-06-27T06:00:12+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/exam4sure.com\/jobs\/wp-content\/uploads\/2023\/07\/remote-jobs.jpeg\" \/>\n\t<meta property=\"og:image:width\" content=\"1024\" \/>\n\t<meta property=\"og:image:height\" content=\"512\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"exam4sure@blogadmin\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"exam4sure@blogadmin\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/exam4sure.com\/jobs\/denials-specialist-remote\/\",\"url\":\"https:\/\/exam4sure.com\/jobs\/denials-specialist-remote\/\",\"name\":\"Denials Specialist - Remote\",\"isPartOf\":{\"@id\":\"https:\/\/exam4sure.com\/jobs\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/exam4sure.com\/jobs\/denials-specialist-remote\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/exam4sure.com\/jobs\/denials-specialist-remote\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/exam4sure.com\/jobs\/wp-content\/uploads\/2023\/07\/remote-jobs.jpeg\",\"datePublished\":\"2024-06-27T06:00:12+00:00\",\"dateModified\":\"2024-06-27T06:00:12+00:00\",\"author\":{\"@id\":\"https:\/\/exam4sure.com\/jobs\/#\/schema\/person\/911705547976b87bb88c5b29925ed074\"},\"description\":\"Denials Specialist - Remote , online remote jobs , online work from home jobs , remote job work from home , service online jobs\",\"breadcrumb\":{\"@id\":\"https:\/\/exam4sure.com\/jobs\/denials-specialist-remote\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/exam4sure.com\/jobs\/denials-specialist-remote\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/exam4sure.com\/jobs\/denials-specialist-remote\/#primaryimage\",\"url\":\"https:\/\/exam4sure.com\/jobs\/wp-content\/uploads\/2023\/07\/remote-jobs.jpeg\",\"contentUrl\":\"https:\/\/exam4sure.com\/jobs\/wp-content\/uploads\/2023\/07\/remote-jobs.jpeg\",\"width\":1024,\"height\":512,\"caption\":\"Staff Solar Technician\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/exam4sure.com\/jobs\/denials-specialist-remote\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/exam4sure.com\/jobs\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Denials Specialist &#8211; 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