Denials Management Coordinator

1 week ago

Morgantown, United States CAMC Health System Full time
Job Summary

In an environment of continuous quality improvement, the Denials Management Coordinator is responsible for the review of all denials to determine patterns in errors, payors, and internal processes to improve our denial rate. Exhibits the MHS Standards of Excellence and exercises strict confidentiality at all times.

Responsibilities

Reporting & Analysis
Conducts denial root cause analysis to identify opportunities for error reduction. Prepares reports as required by management regarding audit results, process improvement recommendations and systemic payment errors. Makes monthly observations and recommendations to prevent future denials.

Education
Works with front line/education staff and educate on proper processes. Establishes and manages a cross departmental/functional Denials Mitigation Team. Coordinates all efforts of Clinical Nurse Review.

Documentation
Ability to verbalize to insurance carriers and write appeal details to support additional payment on denied claims. Accurately and consistently documents the results of all denial reviews in the hospital information system.

Knowledge, Skills & Abilities

Light Work: Frequent lifting and/or carrying of objects weighing up to 10 lbs. with a maximum lifting of 25 lbs.

Minimum of two years of previous experience in a healthcare-related position required. Experience in coding, medical necessity, registration, insurances, and precertification processes and/or denials preferred. Minimum of 2 years of experience or formal education in basic ICD10 coding, medical terminology, Anatomy/pathophysiology, and disease process preferred. Depending on healthcare-related experience, may require coding certification within 2 years of date of hire. Experience reviewing ambulatory claim denials preferred.

Education
• Associate's Degree
• Bachelor's Degree

Credentials

Work Schedule: Days

Status: Full Time Regular 1.0

Location: Hartman Run Road

Location of Job: WV:Morgantown:Mon Health Medical Center

Talent Acquisition Specialist: Guy S. Stewart guy.stewart@vandaliahealth.org

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