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.
Work You'll Do
As an Epic Denials Management Coordinator on the AI & Engineering team, you will be responsible for:
- Supporting review denials (835/277 processing) received from third party payers
- 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
- Determining appropriate denial responses based on denial reasons
- Using appropriate templates to develop denial appeal letters for denials and submit to third party payers
- Rebilling corrected claims and routing issues to coding, billing, credentialing, denials, and/or clinical teams as needed
- Providing additional documentation to payers as needed to resolve denial issues
- Documenting denial details, research conducted, and follow-up activities conducted in relevant EMR and patient accounting systems
- 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 to understand claim status and payer requirements to adjudicate claim
- Providing account information to payers as required and resolving issues related to eligibility, authorizations, claim edits, coordination of benefits, and missing documentation
- Adhering to defined SOPs and workflows and working within Epic Resolute Hospital Billing, claims clearinghouse, payer websites and portals, and other systems as required by workflows
- Meeting and exceeding minimum productivity and quality standards; submitting to performance improvement plans as required according to guidance from engagement management
Required Qualifications
- 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
Preferred Skills
- 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
Successful Candidate Attributes
- Ability to work independently and collaborate as part of a team
- Effective written and verbal communication skills
- Meticulous attention to detail and quality of work product
- Ability to build and sustain professional relationships
- Ability to manage and prioritize multiple tasks in a fast-paced and dynamic environment
- Strong interpersonal skills and professional demeanor
- Ability to meet deadlines
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. You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance.