Epic Denials Management Coordinator

Position Summary

Join Deloitte's AI & Engineering practice to support hospital denials management to deliver back-end Revenue Cycle Management (RCM) services, including Billing and Claims Submission, A/R Follow-up, Denials Management, Payment Posting, and Credits and Refunds, for health care provider client. This is a primarily remote role supporting enterprise Epic support, with minimal travel and scheduled onsite time as needed.

About the Role

The Epic Denials Management Coordinator supports review denials (835/277 processing) received from third party payers. Responsibilities include conducting Denial categorization and root cause analysis based on remittance information received from payer, reviewing hospital account records and payer remittance records, communicating with relevant Client RCM and internal hospital stakeholders, and conducting outreach to payers through payer portals and phone calls to gather necessary information to understand denial reasons and root causes. The coordinator determines appropriate denial responses based on denial reasons, uses appropriate templates to develop denial appeal letters for denials and submits to third party payers, rebills corrected claims and routes issues to coding, billing, credentialing, denials, and/or clinical teams as needed, documents denial details, research conducted, and follow-up activities conducted in relevant EMR and patient accounting systems, reviews AR aging reports and work queues to identify unpaid and delayed claims, follows up with third party payers on open denials, denial appeals, and other outstanding balances related to denials to understand claim status and payer requirements to adjudicate claim, provides account information to payers and resolves issues related to eligibility, authorizations, claim edits, coordination of benefits, and missing documentation, adheres to defined SOPs and workflows, and works within Epic Resolute Hospital Billing, claims clearinghouse, payer websites and portals, and other systems and required by workflows.

Responsibilities

• Conduct Denial categorization and root cause analysis based on remittance information received from payer
• Review hospital account records and payer remittance records, communicate with relevant Client RCM and internal hospital stakeholders, and conduct outreach to payers through payer portals and phone calls to gather necessary information to understand denial reasons and root causes
• Determine appropriate denial responses based on denial reasons
• Use appropriate templates to develop denial appeal letters for denials and submit to third party payers
• Rebill corrected claims and route issues to coding, billing, credentialing, denials, and/or clinical teams as needed
• Document denial details, research conducted, and follow-up activities conducted in relevant EMR and patient accounting systems
• Review AR aging reports and work queues to identify unpaid and delayed claims
• Follow up with third party payers on open denials, denial appeals, and other outstanding balances related to denials to understand claim status and payer requirements to adjudicate claim
• Provide account information to payers and resolve issues related to eligibility, authorizations, claim edits, coordination of benefits, and missing documentation
• Adhere to defined SOPs and workflows and work within Epic Resolute Hospital Billing, claims clearinghouse, payer websites and portals, and other systems and required by workflows
• Meet and exceed minimum productivity and quality standards; submit to performance improvement plans as required according to guidance from engagement management

Requirements

• 1+ years of experience in hospital account denial management and appeals
• Experience using Epic Resolute Hospital Billing
• Bachelor's degree in information technology, business, healthcare, or a related field; or equivalent experience
• Experience working in claims clearinghouse systems
• Ability to travel 10%, on average, based on the work you do and the clients and industries/sectors you serve
• Limited immigration sponsorship may be available

Qualifications

• Experience using Microsoft Word, Excel, and PowerPoint
• Experience supporting clinical or healthcare business operations
• Experience managing multiple projects or workstreams
• Experience preparing and delivering technical demonstrations
• Experience analyzing billing workflows, claim issues, or operational data

Benefits

A reasonable estimate of the current range is $50,000 to $60,000 with overtime pay possible.

Pay

$50,000 to $60,000 annually

Schedule

Primarily remote role with minimal travel and scheduled onsite time as needed.