DENIALS MANAGEMENT COORDINATOR

Responsibilities

• Reviews and analyzes current audit information to identify opportunities for improvement internally and payers.
• Maintains reporting specific to audit statuses, identifying internal and payer patterns to better manage payer issues proactively.
• Update and maintain audit tracking spreadsheets outside of RAC software.
• Develop and maintain procedural documentation.
• Identify and resolve system and payer issues that result in payment delays, incorrect payments.
• Service as a PFS, PAS, HIM, Compliance, Contract Management, Clinical Liaison to third party payers, and other parties in a problem-solving or information capacity.
• Monitor deadlines and ensure all parties meet timely filing for appeal deadlines.
• Audit involving any third-party commercial payer.
• Participate in payer meetings to discuss appeal progress and identify trends with payer processing appeals to resolve cases.
• Establish and enforce internal audit policies including pre-payments audits.
• Collect and analyze data from audits and concurrent reviews to identify recurring problems.
• Acts as a coordinator and mentor to RID Denial Staff.

Qualifications

• Minimum of an Associate’s Degree in Business, Paralegal Studies, Coding, Healthcare, or related field.
• Two (2) years of relevant experience in Compliance, Coding, HIM, Insurance denials, or Legal experience may be considered in lieu of an Associate’s degree.
• Minimum three (3) years’ experience within the healthcare field performing any variety of organizational, administrative, or process improvement functions.