Monday, October 21, 2013

Disputed Claims Supervisor - Anaheim, CA


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 communication s, and value-based care solutions, we empower healthcare decision makershospitals, health systems, physicians, self-insured employers, and payersto 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 Disputed Claims Supervisor.


Responsible for first level management of denials, unpaid/underpaid appeals process for all Managed Care, Commercial, Workers Compensation and Some Government Payors for all patient accounts. Responsible for first level management of revenue recovery efforts on all Managed Care, and Commercial Workers Compensation payors for all patient accounts.

Oversees day to day operations of assigned staff. Manages assigned inventory to ensure accounts are worked timely and appropriately. Escalates underpayment variances or denials to NIC Management for further escalation.


Include the following. Others may be assigned.

  • Ensures proper and timely denials, unpaid/underpaid appeals process; ensures proper and timely submission of appeals denials and unpaid/underpaid claims.

  • Ensures proper recording and routing of accounts for corrective actions, additional information and accounts for clinical review. Daily management of staff and dispute inventory which includes account reviews, QC, Productivity, Time and Attendance and general HR processes.

  • Facilitates the identification of issues and solutions by team members related to the denials, unpaid/underpaid claims and appeals; escalates any unresolved issues to Denials Manager.

  • Monitors and ensures issues identified are routed to the Plan Specialist and Pre-Legal Specialist, Terms and Conditions and DPS with all the proper documentation required.

  • Ensures all denials, unpaid/underpaid accounts are appropriately recorded in the DA Screen of the ACE System and appealed as necessary.

  • Coordinates payer projects with Plan Specialists or LVIT

  • Escalates billing or T&C issues for resolution

  • Attends payer and Managed Care conference calls or onsite meetings

  • Works with Denials Manager for planning agendas for special projects needed to maximize revenue recovery.

  • Prepares EOM variance reports per guidelines

  • Performs quarterly reviews and provides feed back to team members.

  • Ensures compliance with state and federal laws regulations for Managed Care and other third party payors.



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 to advanced understanding of Explanation of Benefits form (EOB), managed care contracts and hospital billing form requirements (UB92 and HCFA 1500)

  • Intermediate to advanced understanding of ICD-9, HCPCS/CPT coding and medical terminology

  • Intermediate writing skills

  • Intermediate Microsoft Office (Word, Excel)


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

  • 4 year college degree in Business or Healthcare Administration preferred

  • 3 - 5 years experience in a hospital business environment performing billing and/or collections

  • 3-5 years prior supervisory experience.


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


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


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