Denial Management Coordinator

Job Description

The Denial Management Coordinator is responsible for managing the current appeals process at Midland Memorial Hospital. The coordinator will review denied claims and carry out the current appeals process while also resolving contract variances on patient encounters. Will identify denial trends and work collaboratively with various departments to develop prevention measures. Works to maintain third-party payer relationships, including responding to inquiries, complaints, and other correspondence. Knowledgeable of state/federal laws that relate to contracts and to the appeals process. Coordinator will work independently to process claims.

SHIFT AND SCHEDULE

Monday-Friday 8:00 AM - 5:00 PM

ESSENTIAL FUNCTIONS/PERFORMANCE EXPECTATIONS

• Executes the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party payers in a timely manner
• Tracks the status and progress of denials and appeals
• Conducts internal and external correspondence accurately, clearly, concisely, and professionally while following organizational regulations
• Maintains data on the types of claims denied and root causes of denials, and collaborates with team members to make recommendations for improvements and resolving issues
• Prepares, maintains, assists with, and submits reports as required
• Regularly makes complex decisions within the scope of the position, and is comfortable working independently
• Identifies and resolves reimbursements and variance issues to resolve payment discrepancies (e.g., denials, underpayments, etc.)
• Analyzes all coding adjustments made on EOB to determine payment accuracy and valid support
• Works directly with case management on denial trends and strategies to appeal successfully.
• Works collaboratively with contract variance team on denial trends they are seeing and verifying if the denials are valid according to current CMS/payor contract guidelines.
• Works with various departments in the hospital to develop denial prevention measures.

EDUCATION AND EXPERIENCE

• High school diploma or equivalency required
• Associate degree is preferred.
• Demonstrated technical knowledge.
• Analytic skills and the confident ability to make quick, effective decisions under pressure
• Strong organizational and prioritization skills.
• Strong oral and written communication skills.
• Must have acceptable keyboard and 10-key skills, along with strong knowledge of Word, Excel, Access, and other general computer expertise, or an equivalent combination of education and experience.
• 5+ years medical billing office experience

PHYSICAL REQUIREMENTS To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The individual must be able to:

• Stand, walk, sit, stoop, reach, lift, see, speak and hear.
• Lifting is limited to 35 lbs. for clinical staff and to 50 lbs. for non-clinical staff.The individual must use an assisted-lift device