Denials Management Coordinator - Denials Management - FT 1.0 (80 hrs biweekly) (74494)

Memorial Health System • Reno, OH

1d

About The Position

In an environment of continuous quality improvement, the Denials Management Coordinator reviews denials to identify patterns involving errors, payors, and internal processes, with the goal of improving the denial rate. The coordinator exhibits the MHS Standards of Excellence and maintains strict confidentiality. The role includes educating frontline staff, communicating with insurance carriers, documenting denial-review results, and preparing reports and recommendations for management. Other duties and responsibilities may be assigned as necessary.

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 orientation 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.
• Coding certification may be required within two years of hire, depending on healthcare-related experience.
• Experience reviewing ambulatory claim denials.

Responsibilities

• Analyze denials to identify patterns.
• Work with frontline staff and educate them on proper processes.
• Communicate with insurance carriers and prepare appeal details to support additional payment on denied claims.
• Accurately and consistently document denial-review results 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 prevent future denials.
• Assume other duties and responsibilities as necessary.

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