The Medical Denials Coordinator plays a critical financial role in the billing department by identifying, managing, monitoring, and preventing denials through an effective denial management process.
The coordinator will review all referred accounts to determine categorization, level of appeal, and process steps; and establish a trend between recurring denial reason codes and denial reason codes.
Essential Position Functions:
- Pinpoint the registration, billing, and medical coding setbacks through trend tracking and correct them to prevent future denials.
- Identify the root cause and reason for claim denials.
- Analyze the payment patterns for individual payers so that it becomes effortless to detect a diversion from the normal trend.
- Post all insurance payments, and contractual and non-contractual adjustments for assigned carriers and transfer outstanding balance to secondary insurance or patient responsibility per EOB protocol.
- Update cash spreadsheets and run collection reports.
- Report and follow up on payment and denial trends.
- Monitor reimbursement from managed care networks and insurance carriers to ensure reimbursement is consistent with contracted rates.
- Perform collection activities, such as working aged accounts/AR reports to ensure timely and proper maximum reimbursement through various methods including insurance company websites, phone calls, etc.
- Provide professional, accurate, and timely responses to all accounts receivable inquiries.
- Call insurance companies regarding any discrepancy in payments, when necessary.
- Identify and bill secondary or tertiary insurance.
- Review accounts for insurance follow-up.
- Research and appeal denied claims.
- Respond and follow up on payers’ correspondence.
- Answer insurance telephone inquiries on assigned accounts.
- Works on other projects as needed.
Required Knowledge, Skills, and Abilities:
- 2+ years of denial management experience
- Ability to meet defined performance and production goals.
- Excellent verbal and written communication skills
- Excellent organizational skills
- Close attention to detail
- Ability to multitask and meet tight deadlines.
- Excellent problem-solving skills
- Ability to manage time with little supervision.
- Maintain patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Job Type: Full-time
Pay: $52,000.00 - $57,000.00 per year
Benefits:
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Work setting:
Education:
- High school or equivalent (Required)
Experience:
- ICD-10: 1 year (Preferred)
- Medical billing, coding, and denial: 2 years (Required)
- Microsoft Excel: 1 year (Preferred)
Ability to Commute:
Work Location: In person