Denials Coordinator

Corewell Health • Caledonia, MI

1d • Onsite

About The Position

Ensures that timely, accurate and complete data is submitted to appropriate insurance companies to guarantee prompt payments to Corewell Health. Communicates and collaborates with the multidisciplinary team through verbal and written communication. Participates with Care Team for the integration of the patient to the home or transitional environment by developing, planning, implementing and evaluating in accordance with current existing federal, state and local standards. Adheres to confidentiality policies specific to communications, patient confidentiality, record keeping and coordination services.

Requirements

• High School Diploma or equivalent
• 2 years of relevant experience
• Related work in a clinical office or health insurance setting
• Working in an organization of size and complexity comparable to Corewell Health

Nice To Haves

• Associate's Degree Business Administration, Management, Commerce, Communications, Public Relations or other related degree or equivalent combination of education and experience

Responsibilities

• Understanding of the revenue cycle and the responsibility and goals of each area and how they impact the revenue cycle.
• Review all accounts that have a payer denial based on the Denial Management Policy and Procedure and take appropriate action based on the type of denial.
• Documents all necessary elements; reason for denial/audit, denial status, action taken in the electronic medical record per denial management policy.
• Understanding of current payer contracts.
• Apply corrections to patient demographics, charges, adjustments, and payments or when needed forwards to the appropriate department for correction.
• Identify and provide communication and education on trends identified.
• Appeal denials based on the appeal criteria found within the Denial Management policy and within appropriate denial due date timeframes.
• Work with facility departs when necessary for resolution or appeal of denials related to that department (i.e Lab, Patient Access, Case Management).
• Prepare and distribute a monthly denial log by facility to include account number, payor type, reason for denial when requested.
• Identifies and communicates monthly denial trends and provides education as necessary to avoid recurring denials for the same denial reason code.
• Send identified medical records as part of the denial/audit process via variety of methods- expedited mail, electronic portal, payor portal or expedited ground currier service.
• Will document appeal/additional documentation was sent in the electronic medical record once completed.
• Follows payor or contractor denial/audit rules and timelines as outlined.
• Performs appropriate follow up with payors on status of appeals/audits.
• Follows appropriate next steps when denial has been upheld and completes correct adjustment process after the first level of denial is upheld.
• Maintains a professional image and provides excellent customer service.
• Inputs data from various sources (insurance companies, admissions, certification, and other hospitals) into Care Management discharge planning software and insures communication to members of Care Team.
• Processes and prepares clinical reviews completed by Care Management Department (CMD) employees for confidential transmission to third party payers.
• Maintains ongoing communication between Corewell Health (CH) and third party payers related to the number of hospital days authorized, additional requests for clinical information, anticipated discharge needs, etc.
• Supports specific third party payers by obtaining authorization for services; providing accurate & timely admission/discharge dates; updating CMD and SH employees on any demographic changes; problem solving issues/concerns third party payer may have.
• Reports reviews needed to case manager.

Benefits

• Comprehensive benefits package to meet your financial, health, and work/life balance goals.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance, pet insurance
• Traditional and Roth retirement options with service contribution and match savings

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED