Coordinator, Denials Management

 About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.  

JOB SUMMARY:

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

Essential Duties & Responsibilities:

• Differentiates between clinical and technical denials through EOB'S, denial letters/payer correspondence and data mining.
• Identifies payer and hospital’s managed care contracts.
• Reviews managed care contracts against application of rates, provisions and terms.
• Reviews timely filing guidelines regarding the appeals process.
• Contacts payers to negotiate resolution on technical denials.
• Appeals denials using all means necessary (appeal letters, medical records and other supporting documentation, utilization of on-staff clinicians).
• Evaluates appeal outcome for next steps (logs recovered funds, supports uphold decision or initiates 2nd level appeal).
• Manages assigned workload of accounts through timely follow up and accurate record keeping.

Qualifications:

• Four-year degree preferred or equivalent experience in hospital related claims/ billing/ follow-up field
• Benefits/fund administration experience preferred.
• Knowledge of/experience working with managed care contracts.
• Experience working with customer support/client issue resolution management.
• Strong analytical acumen.
• Strong multi-tasking skills.
• Proficiency with MS Office.
• Excellent oral and written communication skills. 

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.