Denial Management Coordinator

3 weeks ago


Hattiesburg, Mississippi, United States Forrest General Hospital Full time
Job Title: Denial Management Coordinator

At Forrest General Hospital, we are seeking a highly skilled Denial Management Coordinator to join our team. As a key member of our revenue recovery team, you will play a critical role in ensuring timely reimbursement for our patients.

Key Responsibilities:
  • Perform retrospective medical record chart reviews to ensure timely reimbursement.
  • Manage denied cases in a timely manner and possess a sense of urgency to turn around cases based on payer rules and guidelines.
  • Collaborate with physician(s), physician's office staff, registration staff, and Patient Finances Services to obtain necessary information to support medical necessity.
  • Work with Business office, Patient Finance Service, and HIM departments to coordinate and ensure requirements are met for Centers for Medicare & Medicaid Services, such as Recovery Audit Contractors, Medicare's MAC, private insurances, and other governmental entities.
  • Function as a resource person to various departments involved in the review process.
  • Utilize written criteria, standards, local and national coverage of determination and norms to evaluate medical records and documents for appropriateness of level of care.
  • Support the Utilization Review function of the hospital by working closely with Physician Advisors of Case Management.
  • Attend Utilization Management Committee meetings and report on monthly denial/appeal activities.
  • Provide performance indicators and opportunities for improvement for the case management department.
  • Act as a liaison position between the hospital and payer source, tracking and trending denials by DRG, Physicians, & payer.

We are looking for a highly motivated and detail-oriented individual with excellent communication and analytical skills. If you are passionate about revenue recovery and have a strong background in healthcare, we encourage you to apply for this exciting opportunity.



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