Clinical Denials Coordinator, Revenue Cycle Management, Full Time, Days

Jackson Health • Miami, FL

71d • Onsite

About The Position

Clinical Denials Coordinator is responsible for back up coverage within the entire Utilization Review team within Revenue Cycle which includes: Utilization Review within the (Emergency Dept area, Inpatient Utilization Review area, and all workflows within the Central Clearance Center functions as needed. Clinical Denials Coordinators are also responsible for reviewing denied accounts, establishing trends, identifying operational improvement opportunities, working with the impact areas to correct and improve weaknesses within their processes that leads to denials. Audit accounts as needed, and address clinical issues leading to denials. Work with payors on focused audits and coordinate the clinical audits. Work closely with the denial agencies on reporting and placements. Work with Utilization leadership on any assigned team projects.

Requirements

• Generally requires 3 to 5 years of related experience.
• Bachelor's in Science required with a certification as a PA, LPN or RN.

Nice To Haves

• Preferred past payer experience specifically with utilization review, denials, audits, and/or appeals.
• Master's degree preferred and/or certification as ARNP or Foreign Medical Graduate.
• Valid PA, LPN or RN is preferred.

Responsibilities

• Audit denied or potentially denied accounts to determine true denial reason.
• Collaborate with denial agencies on identifying trends and reporting to denial committees.
• Work closely with payors and JHS managed care department and manage projects focused on resolving denials and improving recoveries.
• Coordinate denial committee meetings at each facility and ensure reviews and reports are completed timely and presented at each meeting.
• Assist the CBO in reconciling placements and recoveries monthly to ensure Siemens and Connance are in balance.
• Coordinate with CFO's and denial committee teams at each facility to ensure net denial targets are met.
• Crosstrain and assist with invoice reconciliation as needed.
• Assist with internal and external audit requests relating to denials as requested by management.
• Performs other related duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1,001-5,000 employees