Denials Coordinator – Hospital Billing Patient Financial Services – Corporate 42nd Street – Full-Time – Days

A hospital denial coordinator manages and resolves denied insurance claims to help the hospital recover revenue. Key responsibilities include analyzing claim denial reasons, identifying denial trends, sharing trends and findings with owner areas, coordinating the appeals process, collaborating with departments to prevent future denials, maintaining documentation including issue logs with updates, denied dollars and resolutions, and acting as a resource for staff regarding denial-related issues and payer rules.  This person will escalate issues to management if deadlines are missed, payer responses are not received, or when barriers or process gaps are identified. 

• Analyze Denials: 
  • Review and investigate denied insurance claims to understand the specific reasons for denial
• Appeal Management: 
  • Initiate, track, and coordinate the appeals process for denied claims, ensuring all necessary documentation and timely follow-up are completed. 
• Trend Identification: 
  • Analyze denial data to identify patterns and root causes of denials and underpayments. 
• Process Improvement: 
  • Work with various hospital departments (e.g., coding, billing, clinical) to develop and implement solutions to prevent future denials and improve processes
• Payer Relations: 
  • Maintain relationships with insurance payers to facilitate claim resolution and address ongoing issues. 

• Documentation and Reporting: 

   

  • Maintain accurate records of all denial and appeal activities, including logs and system records, and prepare reports for management on denial trends. This includes routine report outs of identified trends, next steps, resolutions or barriers to resolution
• Resource: 
  • Serve as a point of contact for staff questions regarding denial rationale, timely filing, payer policies, and the appeals process
• Compliance:
  • Ensure adherence to regulatory compliance, such as HIPAA, and stay informed about payer and Medicare/Medicaid guidelines. 

•  HS/GED; Bachelors degree preferred 
• Three years of experience within hospital healthcare revenue cycle, performing administrative or process improvement type functions
• Strong knowledge of Epic Resolute hospital billing
• Knowledge of healthcare revenue cycle, insurance policies, coding (ICD-10, CPT), and denial management systems. 
• Strong analytical and problem-solving skills. 
• Excellent communication and interpersonal skills to collaborate with internal teams and external payers. 
• Ability to organize and manage multiple tasks and deadlines. 
• Proficiency with relevant software and databases, including Electronic Medical Records (EMRs).