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 role involves determining appropriate denial responses based on denial reasons, developing denial appeal letters, rebilling corrected claims, and resolving denial issues by providing additional documentation to payers as needed. Documentation of denial details, research conducted, and follow-up activities conducted in relevant EMR and patient accounting systems is also required. Additionally, the coordinator is responsible for reviewing AR aging reports and work queues to identify unpaid and delayed claims, following up with third party payers on open denials, denial appeals, and other outstanding balances related to denials, and providing account information to payers to resolve issues related to eligibility, authorizations, claim edits, coordination of benefits, and missing documentation.

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
• Conduct Outreach to Payers Through Payer Portals and Phone Calls to Gather Necessary Information
• Determine Appropriate Denial Responses Based on Denial Reasons
• Develop Denial Appeal Letters Using Appropriate Templates and Submit to Third Party Payers
• Rebill Corrected Claims and Route Issues to Coding, Billing, Credentialing, Denials, and/or Clinical Teams as Needed
• Provide Additional Documentation to Payers as Needed to Resolve Denial Issues
• 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

Preferred

• 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

Qualifications

• Required: 1+ Years of Experience in Hospital Account Denial Management and Appeals
• Required: Experience Using Epic Resolute Hospital Billing
• Required: Bachelor's Degree in Information Technology, Business, Healthcare, or a Related Field; or Equivalent Experience
• Required: Experience Working in Claims Clearinghouse Systems
• Required: Ability to Travel 10%, on Average, Based on the Work You Do and the Clients and Industries/Sectors You Serve
• Preferred: Experience Using Microsoft Word, Excel, and PowerPoint
• Preferred: Experience Supporting Clinical or Healthcare Business Operations
• Preferred: Experience Managing Multiple Projects or Workstreams
• Preferred: Experience Preparing and Delivering Technical Demonstrations
• Preferred: Experience Analyzing Billing Workflows, Claim Issues, or Operational Data

The team AI & Engineering leverages cutting-edge engineering capabilities to build, deploy, and operate integrated/verticalized sector solutions in software, data, AI, network, and hybrid cloud infrastructure. These solutions are powered by engineering for business advantage, transforming mission-critical operations. We enable clients to stay ahead with the latest advancements by transforming engineering teams and modernizing technology & data platforms. Our delivery models are tailored to meet each client's unique requirements. Our Industry Solutions offering provides verticalized solutions that transform how clients sell products, deliver services, generate growth, and execute mission-critical operations. We deliver integrated business expertise with scalable, repeatable technology solutions specifically engineered for each sector.

Pay

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

Schedule

Remote role with minimal travel and scheduled onsite time as needed.