This fully remote Denials Specialist role supports a national healthcare revenue cycle operation headquartered in Frisco, TX, serving clients across more than 135 local regions nationwide. The position sits at the intersection of managed care contract interpretation, payer appeals, and denial trend analysis — making it a strong fit for experienced revenue cycle professionals who want meaningful work, schedule flexibility, and a comprehensive benefits package without leaving home.
Perks and Benefits
- Hourly pay range: $18.60 – $28.00, depending on location, qualifications, and experience
- Signing bonus available for qualified new hires, subject to employment status
- 401(k) with up to 6% employer match
- Medical, dental, vision, disability, and life insurance
- Paid time off (vacation and sick leave) — minimum 12 days per year, accruing at approximately 1.84 hours per 40 hours worked
- 10 paid holidays per year; Conifer-observed holidays paid at time and a half
- Health savings accounts (HSA); healthcare and dependent flexible spending accounts (FSA)
- Employee Assistance Program and employee discount program
- Voluntary benefits: pet insurance, legal insurance, accident and critical illness insurance, long-term care, elder and childcare support, AD&D, auto and home insurance
- Colorado employees receive paid leave in accordance with Colorado's Healthy Families and Workplaces Act
Practice Highlights
- Fully remote position — work from home with no required on-site presence
- Validate denial reasons following EOB review and ensure accurate coding in the DCM system to reflect each denial reason
- Generate payer-specific appeals and online reconsiderations based on dispute reason and contract terms
- Research managed care contract language and compile supporting documentation for appeals, including Terms & Conditions for IMaCS (Internet-enabled Managed Care System) adjudication issues
- Coordinate with the Clinical Resource Center (CRC) for clinical consultations or account referrals as needed
- Escalate exhausted appeal efforts and denial or payment variance trends to NIC leadership for payer-level escalation
- Route overpayment accounts to the refund unit following contract research and determination of corrective action
- Work payer-directed projects as assigned, supporting a client base spanning 135+ regional markets nationwide
- Organization brings 30 years of healthcare revenue cycle expertise with a focus on transitioning clients from volume- to value-based care models
Qualifications
- High school diploma or equivalent required; some college coursework preferred
- 3–5 years of experience in a hospital business office environment performing billing and/or collections
- Intermediate understanding of Explanation of Benefits (EOB) forms, managed care contracts, contract language, and applicable federal and state requirements
- Intermediate knowledge of hospital billing form requirements, specifically UB-04
- Intermediate understanding of ICD-9, HCPCS/CPT coding, and medical terminology
- Intermediate proficiency in Microsoft Office (Word and Excel)
- Advanced business writing skills, including correct grammar and punctuation for formal appeal correspondence
- Candidates must be able to provide confirmation of all required vaccinations and screenings prior to start of employment, including COVID-19 and influenza vaccinations, as applicable and permitted by law
About the Community
This position is fully remote, open to candidates across the United States. The corporate home base of Frisco, TX places the organization within the Dallas–Fort Worth metroplex — one of the fastest-growing and most economically dynamic regions in the country, known for its low cost of living relative to other major metros, no state income tax, and a wide range of suburban and urban lifestyle options. Remote employees enjoy the flexibility to live and work wherever they choose while contributing to a national healthcare revenue cycle platform.