Denials Management Coordinator - Denials Management - FT 1.0 (80 hrs biweekly)

MEMORIAL HEALTH SYSTEM • Reno, OH

3d • Onsite

About The Position

In an environment of continuous quality improvement, the Denials Management Coordinator reviews denials to identify patterns in errors, payors, and internal processes and help improve the denial rate. The role requires exhibiting the MHS Standards of Excellence and maintaining strict confidentiality. The coordinator works with front-line staff on proper processes and communicates with insurance carriers through verbal discussions and written appeals to support additional payment on denied claims.

Requirements

• High school diploma or GED.
• At least two years of previous experience in a healthcare-related position.
• Computer skills, including word processing, spreadsheet, graphics, and database software applications.
• Strong quantitative, analytical, and organizational skills.
• Strong negotiation skills.
• Proficiency in payment review systems, hospital information systems, and coding methodologies.
• Ability to understand medical records, hospital bills, and the charge master.
• Ability to understand ancillary department functions for the facility.
• Ability to understand complex insurance terms and payment methodologies.
• Ability to negotiate effectively with insurance carriers and customers.
• Ability to use and understand computer technology.
• Oral and written communication skills.
• Team-oriented approach and strong interpersonal skills.

Nice To Haves

• Experience in coding, medical necessity, registration, insurance, precertification processes, and/or denials.
• At least two years of experience or formal education in basic ICD-10 coding, medical terminology, anatomy/pathophysiology, and disease processes.
• Experience reviewing ambulatory claim denials.
• Depending on healthcare-related experience, coding certification may be required within two years of the hire date.

Responsibilities

• Analyze denials to identify patterns.
• Work with front-line staff and educate them on proper processes.
• Communicate with insurance carriers and write appeal details to support additional payment on denied claims.
• Document the results of denial reviews accurately and consistently in the hospital information system.
• Prepare reports for management regarding audit results, process-improvement recommendations, and systemic payment errors.
• Make monthly observations and recommendations to help prevent future denials.
• Assume other duties and responsibilities as necessary.
• Exhibit the MHS Standards of Excellence and maintain strict confidentiality.

Benefits

• Affordable, comprehensive benefits package for full-time and flex-time employees.
• Bonus eligibility for qualifying full-time or flex-time employees; eligibility is determined upon offer.

What This Job Offers

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