Denials Lead Specialist

JOB SUMMARY

Responsible for providing assistance, coaching and training to staff members, including new hires. They support and assist the Team, the Supervisor and Management with complex inventory and issue resolution. Responsible for all aspects of disputes and appeals. May assist in special projects as assigned my management.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Assist with training and development of new hires and subsequent training needs. Provide assistance, coaching and training to staff members. Provide enhanced training and assist staff with techniques to increase production, quality and collections. Participate in the new hire peer interviewing process.
• Participate and attend meetings, training seminars and in-services to develop job knowledge. Attend various conference calls, webinars or advanced training to provide assistance to the team members. Respond timely to emails and telephone messages from the staff, management and the client. Effectively communicate issues to management, including payer, system or escalated account issues as well as develop solutions.
• Assist in special projects assigned by management. Keep projects on track for timely delivery
• Triage customer service and client account related requests and escalate them as appropriate. Administrative tasks and other duties based on business and client need.
• Report the flow of day-to-day operations and the impact of daily challenges for supervisor review

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.

• Effective verbal and interpersonal skills
• Knowledge and understanding of the Credits process
• Healthcare terminology and reimbursement rules
• Insurance Plan payment methodologies and contract terms
• Leadership qualities of ownership, personal responsibility and good decision making

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.

EDUCATION / EXPERIENCE

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

• High School Diploma or equivalent
• Three or more years of Disputes background or equivalent combination of experience and education.

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.

• Must be able to work in sitting position, use computer and answer telephone
• Ability to travel
• Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments

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.

• Office Work Environment
• Hospital Work Environment

OTHER

• Proficient in the use of MS Office suite. Intermediate-to-Advanced Excel and Word skills required. PowerPoint helpful.
• Clear, effective and accurate verbal and written communication skills required.
• Organizational and prioritization skills sufficient to effectively manage multiple, concurrent initiatives in a deadline-driven environment required.
• Self-discipline sufficient to work with minimal supervision required.
• Ability to embrace and comply with Conifer Patient Communications policies and Corporate Ethics guidelines required.
• Handling of all PHI (Protected Health Information) and Patient Identifiable Data with discretion and confidentiality required.
• The incumbent will have no fiscal responsibility.
• The incumbent will have no supervisory responsibility.

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!

Compensation and Benefit Information

Compensation

• Pay: $22.56 - $33.85 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.

Benefits

Conifer offers the following benefits, subject to employment status:

• 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.

Salary : $23 - $34