Denial Coordinator

Wood County Hospital is currently accepting applications for a full time Denial Coordinator. The Denial Coordinator reviews and analyzes all inpatient and outpatient denials for opportunities to control, appeal and eliminate denials.  Provides education to involved parties within the denial cycle for quality improvement.  Collects data regarding denials for purposes of trending and improvement.

Shift Details:

• Full Time 40 hours per week
• 0800am-430pm

Job Duties:

• • Accurately prepares inpatient denial log to be used for trending and reporting to the UR committee.  
  • Reviews requests for denial write-offs and recommends action.
  • Prepares and coordinates written appeals for medical necessity denials.
  • Monitors and follows up on medical necessity denials with payers until resolution is reached.
  • Receives and reviews correspondence from third party payers, relating to claims that have been rejected or require additional information
  • Provides an ongoing 12-month summary of monthly denials by transaction to management with appropriate responses. 
  • Stays abreast of third-party payer requirements for billing, medical necessity, authorization and appeals management.
  • Contacts ordering physicians for records/updated orders for the purpose of filing appeals/redetermination using payer specific forms; follow up on appeals
  • Process credit balances accounts, correcting adjustments, refunding payers and/or patients overpayments, completing adjustment requests as needed; contacting insurances and/or guarantors to resolve coordination of benefit problems
  • Received and reviews refund requests received from payers, processing them or appealing as needed, working with billing staff and director for appeal rationale

  Requirements:

• High school diploma required
• Experience with medical terminology, preferred  

Benefit Summary:

Join our team, and you’ll have access to a cutting-edge facility with state of the art technology. You’ll also interact with some of the region's top notch healthcare professionals. You’ll find plenty of opportunities to grow and advance your career.

We’ll also reward your hard work with:

• Great health, dental and vision plans
• Competitive wages
• Prescription drug coverage
• Flexible spending accounts
• Life insurance w/AD&D
• Generous short term and long term disability plans
• Employer-matched 403(b)
• Employer sponsored cash balance pension plan
• Vacation and Holiday time
• Generous tuition reimbursement
• And a lot more

                                                                                                                                                       2408-017

Powered by JazzHR

3AVHCdICGX