Denial Coordinator

Holyoke Medical Center is in need of an experienced Denial Coordinator

Responsiblities:

• Reviews all denial accounts for categorization, level of appeal, special requirements for initiating appeals.
• Create and maintain a clinical appeal process for all inpatient denials assuring that proper documentation is provided to support appeals of unauthorized inpatient days or days denied for lack of documentation.
• Create and maintain a clinical appeal process for outpatient denials where a referral was not obtained and clinical documentation is required.
• Utilizes denial reports to assess root causes and identify trends. Share findings with stakeholders
• Leads a Denials Management Stakeholders team; monitoring identified issues and process
• Work with highest level of appeal cases; Refer appropriate cases to Physician Advisors and fiscal attorney
• Coordinates all second level appeals that cannot be referred to attorney consultants
• Coordinate timely processing of appeal at all levels

Requirements:

Qualifications/Requirements

• High School diploma equivalent required
• Minimum of 3 years of related experience in a medical, hospital or healthcare-related environment with at least one year of experience in a hospital billing department
• Experienced in healthcare claims processing preferred, knowledge of federal healthcare reimbursement systems a plus
• Strong written and verbal communication skill
• Excellence in Excel and Word
• Strong analytical, organizational and time management skills required
• Ability to learn quickly, build and maintain long term relationships and work with minimal supervision
• Knowledgeable in FDCPA and MA FDCPA regulations