West Suburban Medical Center Denials Specialist in Dallas, Texas

Denials Specialist (Job Number: 1605046328)


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!
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.
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.



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.


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

Primary Location: TX-Dallas

Organization: 238-Conifer - Dallas - TX