Denial Coordinator
: Job Details :

Overview:The Denial Coordinator is responsible for verifying the validity of claim denials in comparison to Medicare Regulations, Managed Care Contract and Reimbursement Calculators. This role tracks and monitors requests for records and denials maintaining current activity on each recovery and denial record providing essential quality evaluation reports, advice and improvement recommendations. This job manages the appeals process to achieve timely denials resolution and maintains current denial and recovery records and also provides ongoing feedback to stakeholders related to denial trends and participates in denial reduction initiatives.

Talent Pool: Corporate Services/Professional

Responsibilities:

Initiates denials process, including appeals and status requests, same day as receipt of notification, including proactive coordination of fact-finding and intervention with and interaction between payers, regulatory bodies, medical staff, and Health System personnel.Identifies cases for potential denial and utilizes the organization's electronic systems and medical record, in addition to gathering information from appropriate department staff, to avoid a denial determination.Performs documentation and analysis of denials, appeals and status information.Monitors appealed denials to ensure timely payment or rejection of the appeal.Enters required information into the tracking system upon receipt of denial or request from Payor/Contractor.Prepares monthly organization denials reports to be communicated in Denials Meetings.Participates and leads discussions with payors related to resolution of complex claims and reimbursement policy changes.Performs other duties as assigned. Qualifications:

EDUCATION:Required: Associate's DegreeEXPERIENCE:Required: 3 years of experienceLICENSURE/CERTIFICATION/REGISTRY/LISTING: