<p>Job Summary</p> <p>The Denials Coordinator is responsible for all aspects of the facility's payor denial program including, but not limited, to the following: obtaining and analyzing historical denial data for the purposes of identifying trends and areas of opportunity, facilitating denial prevention teams, handling divisional denial prevention report outs (using MedHost modules), coordinating with case managers and other hospital departments in denial prevention efforts, reviewing charts concurrently to ensure documentation/status/authorization is in alignment with third-party payor requirements, and working with our provider partners to ensure proper ordering and documentation.</p> <p>Essential Functions</p> <ul> <li>Audits medical records to ensure compliance with the organization's coding procedures and standards. </li><li>Reviews insurance payments and denials and recommends billing corrections. </li><li>Coordinates payor denial and audit activities to ensure timely response for the processing of all payor denials, audit request and appeals. </li><li>Builds and analyzes management reports to identify patterns and trends, and recommends opportunities for improvement related to coding, billing, and any other issues related to denials prevention. </li><li>Performs essential clinical reviews to establish medical necessity for inpatient and outpatient services provided/billed and author effective clinical denial and prior authorization appeal letters to achieve maximum overturn rate. </li><li>Responsible for working complex denial coordination with intra-team members to identify root causes and develop and implement action plans for denial prevention based on root cause analysis findings. </li><li>Works closely with clinical areas to effectively document services performed and understand relationship of documentation, medical necessity, coding and charging for all services provided to prevent payer denials and maximize reimbursement. </li><li>Works collaboratively with health information management coding staff, case management, providers and central billing to resolve payment denials and clinical documentation issues. </li><li>Communicates and coordinates with various individuals/distributions and assist with monitoring of the day to day activities. </li><li>Stays abreast of any applicable third-party payer changes that affect potential payment, as well as government regulatory changes. </li><li>Performs other duties as assigned. </li><li>Complies with all policies and standards. </li></ul> <p>Qualifications</p> <ul> <li>Associate Degree preferred </li><li>Bachelor's Degree preferred </li><li>2-4 years of hospital revenue cycle experience, particularly working with claim denials and writing appeals required </li></ul> <p>Knowledge, Skills and Abilities</p> <ul> <li>Knowledge of CPT, HCPCS, DRG, and revenue codes </li></ul>