Primary Duties

Summary:

The Denials Coordinator is responsible for identifying and managing claim denials due to registration, coding, health plan contract reimbursement parameters, EHR workflows and other variances. Denials Coordinator will also work with Revenue Cycle Steering Committee and facility departments to implement process improvements for denial and write off reduction strategies.

The listing of job duties contained in this job description is not all inclusive. Duties may be added or subtracted at any time due to the needs of the organization.

Responsibilities:

Essential Job Duties and Responsibilities:

1. Reviews reports from claim clearinghouse as well as Explanations of Benefits and Remittance Advices to identify denials, where they occurred, what health plans were involved and how to rectify or record the denial.

2. Review each denied claim with respect to services provided, physician orders, authorizations obtained and patient demographics.

3. Responds to denials and files appeals as necessary or refers denial on to clinical or patient billing areas if appropriate.

4. Review all relevant industry information with respect to services provided, documentation required and denial management.

5. Report to Revenue Cycle Steering Committee, finance, and involved departments all denials with appropriate categorization.

6. Compile a monthly denial findings report documenting findings; to include department, denial issue, and dollar amount, along with patient account number.

7. Assist nursing and ancillary services in identifying areas resulting in lost revenue and inadequate documentation. Assist nursing and ancillary departments in implementing corrective actions to eliminate lost revenue.

8. Identify deficient physician documentation by sending a report for review

9. Identify CDM issues identified as part of an audit. Work with the department to get new charge, description change, J code added etc. to help reduce future denials.

10. Work with the business office (PFS) office to address insurance denials that are related to charge entry or documentation. This could include missing charges, incorrect dates of service, admission dates, large quantity verification on claim etc.

Hours will be dependent on patient census and workload. Ability and willingness to work a flexible schedule, to include after-hours and weekends as necessary.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Benefits

FREE Dental Insurance for employee only with two FREE cleanings each year 

FREE Life Insurance 

FREE Urgent Care visits for qualifying symptoms including medical dependents 

Paid Time Off – 24 days per year accrued in PTO Bank for new-full time employees 

Health Insurance option of High Deductible or PPO Plan 

Health Savings Account with FRHS monthly contribution of $75

Vision Insurance 

Short Term Disability Insurance 

Long Term Disability Insurance 

Critical Illness Insurance 

Accident Insurance 

Supplemental Life Insurance 

Wellness Discounts for Health Insurance  

Smoking Cessation Program 

Met Law Legal Services Program  

YMCA and other local discounts 

How to Apply

https://css-faithregional-prd.inforcloudsuite.com/hcm/Jobs/form/JobPosting%5BJobPostingSet%5D%28100,1063,1%29.JobPostingDisplay?fromlist=JobPosting.JobSearchList&navigation=JobPosting%5BJobPostingSet%5D%28100,1063,1%29.JobPostingDisplayNav&csk.JobBoard=EXTERNAL&csk.HROrganization=100