Denial Management Coordinator

Job Summary

The Denial Management Coordinator serves as the primary point of contact for Memorial Healthcare and the Denial Management Team under the direct supervision of the Manager of Patient Financial Services. Will serve as a role model to all Memorial staff and must be able to problem solve and assist patients, customers, providers and staff. This position's primary function is following up, processing and working all Denials that contributes to the Revenue Cycle. Will exhibit excellent customer service skills, effective communication skills and be a mentor and leader for all staff. Strives for superior performance by consistently providing a product or service to leadership and staff that is recognized as ultimately contributing to the patient and family experience. Recognizes and demonstrates understanding of patient and family centered care.

About the Role

Applies excellent customer service skill.
Maintains confidentiality of all information at all times.
Maintains operating instructions and keeps staff updated and educated.
Completes work within authorized time to assure compliance.
Daily work denied claims identified in Expanse through Denial Management or by denials identified through 835 payment files in Quadax or other available programs or reports.
Critical thinking with the ability to validate the accuracy of the denial in accordance with insurance contracts and billing policies.
Demonstrates the ability to determine correctness of charges and coding.
Secures needed medical record documentation required by or requested by insurance companies when necessary to submit with claims.

Responsibilities

• Work with, when necessary, the Authorization/Benefits/Verification specialists Team to obtain proper authorizations for services
• Report denial trends identified to Revenue Integrity, Patient Financial Services Manager and Revenue Cycle Director
• Work closely with Revenue Integrity Department in identifying payment issues based on contracts
• Effectively disburse information to Patient Financial Services Manager and Director of Revenue Cycle to enable education around denials and solutions to reduce the number of denials
• Work with other departments regarding coding or charge issues related to claims
• Attend or participate in webinars/seminars concerning billing and reimbursement changes
• Work with patients when needed to obtain resolution of accounts
• Must be able to work effectively with others and complete tasks within specified or given deadlines
• Demonstrates knowledge of and supports hospital mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality statements, corporate compliance plan, customer service standards, and the code of ethical behavior

Requirements

• Minimum of 3 years’ experience working in a professional environment
• Minimum of 3 years’ experience working in Denial Management within a facility or professional practice
• PC experience required
• Use of multi-line phone experience required
• Office Procedures required
• Customer Service experience required
• Previous experience as a manager, team lead or trainer – required

Qualifications

• Associates degree preferred
• High school diploma or equivalent is required
• Post high school courses in medical billing, medical terminology is preferred

Skills

• Open, honest and tactful communication skills
• Essential Physical Abilities/Motor Skills
• Essential Technical Abilities
• Essential Mental Abilities
• Essential Sensory Requirements
• Interpersonal Skills

Benefits

N/A

Pay

N/A

Schedule

N/A