Denial Coordinator - Case Management Department - Full Time

In this role you will be

• Facilitating managed care denials/inquiries and forwarding them to the next level of management.
• Processing appeals for mailing.
• Coordinating Medicare, Medical Assistance, and managed care denials/inquiries.
• Coordinating the process to ensure deadlines are met.
• Working closely with contracted physician advisors for appeal and denial management.
• Entering data into the appropriate software programs for reporting purposes, and presenting data and statistics to physician office meetings.
• A member of teams such as the forms committee, audit team, revenue cycle, RAC committee, and mental health networking group.
• Maintaining separate records for various audit contractors.
• Preparing all reports and data for UM committee and as they pertain to the Case Management Department.
• Responsible for keeping staff up to date on payor policies and procedures, and demonstrating familiarity with managed care and third-party payor systems.
• Serving as a resource to staff regarding denials and appeals.
• Facilitating the denial process until final outcomes are received for each case.
• Reviewing daily scheduling and outpatient records to identify precertification issues and notifying the appropriate personnel.
• Serving as a liaison between the medical center and external business partners.
• Working with internal and external customers to remain up-to-date on standards and processes.
• Responsible to address tasks and outstanding items that may impact billing in a timely manner.
• Participates in required meetings to share pertinent data.

Qualifications

• EDUCATION: High school graduate/degree or diploma in a health-related field
• EXPERIENCE:
• o Secretarial experience working with managed care in a healthcare setting o Denials/appeals coordination as well as experience with software including, but not limited to, Davinician, Optum, HER, Challenger preferred. o Experience with Excel, Word and Power point required o Minimum 3 years clinical experience in an Emergency Department, Critical Care, Cath Lab, or related medical setting preferred o Basic computer skills and office equipment experience