Denial Management Coordinator

Midland Health•Midland, TX

About The Position

The Denial Management Coordinator manages Midland Memorial Hospital’s appeals process by reviewing denied claims, processing appeals, and resolving contract variances on patient encounters. The coordinator identifies denial trends, works with hospital departments to develop prevention measures, and maintains relationships with third-party payers by responding to inquiries, complaints, and other correspondence. The role requires knowledge of state and federal laws related to contracts and appeals, and the ability to process claims independently. The position follows a Monday–Friday schedule from 8:00 AM to 5:00 PM. It includes reviewing and tracking denials and appeals, assessing payment accuracy, resolving reimbursement discrepancies, preparing reports, and collaborating with case management, the contract variance team, and other hospital departments.

Requirements

High school diploma or equivalency required.
At least 5 years of medical billing office experience.
Demonstrated technical knowledge.
Analytical skills and the ability to make quick, effective decisions under pressure.
Strong organizational and prioritization skills.
Strong oral and written communication skills.
Acceptable keyboarding and 10-key skills.
Strong knowledge of Word, Excel, Access, and general computer tools, or an equivalent combination of education and experience.
Knowledge of state and federal laws related to contracts and the appeals process.

Nice To Haves

Associate degree preferred.

Responsibilities

Execute the denial appeals process, including receiving, assessing, documenting, tracking, responding to, and resolving appeals with third-party payers in a timely manner.
Track the status and progress of denials and appeals.
Conduct internal and external correspondence accurately, clearly, concisely, and professionally while following organizational regulations.
Maintain data on denied claim types and root causes, and collaborate with team members on recommendations for improvements and issue resolution.
Prepare, maintain, assist with, and submit reports as required.
Make complex decisions within the scope of the position and process claims independently.
Identify and resolve reimbursement and contract variance issues, including denials and underpayments, to resolve payment discrepancies.
Analyze coding adjustments on EOBs to determine payment accuracy and valid support.
Work with case management on denial trends and strategies for successful appeals.
Collaborate with the contract variance team to review denial trends and verify denials against current CMS and payer contract guidelines.
Work with hospital departments to develop denial prevention measures.
Maintain third-party payer relationships by responding to inquiries, complaints, and other correspondence.