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Denials and Appeals Coordinator
GRAHAM REGIONAL MEDICAL CENTER —Graham, TX
- 5 years
- HIPAA
- English
9d

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Denials and Appeals Coordinator
Graham Regional Medical Center —Graham, TX
Tasks that involve handling implements or utensils, use of public or shared bathroom facilities or telephone, and personal contacts such as handshaking are…
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Denials and Appeals Coordinator

GRAHAM REGIONAL MEDICAL CENTER -
Graham, TX

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Job Details

9 days ago

Qualifications

Appeals
Job-specific skills training (staff training program)
Regulatory compliance in claims processing
Coding for hospital billing
English
High school diploma or GED
Medical insurance appeals management
Productivity software
Insurance claims appeal handling
Analytics

Full Job Description

Description

Job Summary:

The Denials & Appeals Coordinator is responsible for managing, tracking, and resolving denials and appeals to ensure timely reimbursement. This role requires in-depth knowledge of payer guidelines, systems, and requirements to navigate complex denial cases effectively, assist in issue resolution, and help identify trends that can improve claim outcomes.

Supervisory Responsibilities:

May have direct reports
Serves as back-up to the Director of Revenue Cycle

Duties/Responsibilities:

Monitors assigned queues and duties across various systems, to ensure all follow-up dates are current.
Analyzes denials to determine appropriate actions, completes appeals, or routes cases for clinical appeals as needed.
Files and monitors appeals to resolve payer denials, documenting all activity accurately and maintaining logs, account notes, and system records.
Collaborates with Revenue Cycle vendors.
Serves as key team member and subject matter expert on denial prevention and coordination.
Identifies training opportunities.
Able to prepare training documents, education and/or presentations for Business Office staff and department leaders as needed.
Maintains an up-to-date understanding of payer guidelines and requirements related to denials and appeals.
Processes internal requests, reviews Government Audit accounts, Payer refund requests related to overpayments and completes necessary rebills and adjustments.
Identifies trends in denials to suggest improvements and reduce future claim issues, providing data for denial and appeal trends as needed.
Assist with, complete, and provide coding and billing documentation to ensure accurate coding and billing practices to maximize revenue and minimize claim denials.
Answer inquiries from patients.
Maintain compliance with relevant regulations, including HIPAA, and payer-specific guidelines
Perform other related duties to benefit the mission of the organization.

Requirements

Required Skills/Abilities:

Strong knowledge of payer specific guidelines, medical billing practices, and appeal processes and medical technology
Able to assist in or lead training of other revenue cycle staff as needed
Attend leadership meeting related to Revenue Cycle for both Clinics and Hospital.
Able to provide appropriate communication and follow-up to the teams

Proficiency in relevant software and claims management systems, such as Meditech, Quadax and Athena a plus
Excellent analytical skills for reviewing denial trends and suggesting improvements
Strong verbal and written communication skills to interact with payers and internal departments
Ability to prioritize tasks effectively and manage time in a fast-paced environment
Intermediate computer skills, including but not limited to: Microsoft Office, electronic medical record, and email
Strong command of / proficient in spoken and written English
Strong attention to detail
Ability to multi-task with multiple interruptions

Education and Experience:

Highschool diploma or GED required; Associate Degree or higher in Health Information Management preferred
5+ years of experience in hospital billing, revenue cycle, or claims denials and appeals processing require
Prior experience with revenue cycle processes in a hospital required. Physician practice experience a plus
CPC a plus

Physical and Mental Requirements:

Prolonged periods sitting at a desk and working on a computer
Must be able to lift up to 25 pounds at times
Must be able to navigate various departments of the organization’s physical premises
Sufficient hearing, vision, and dexterity to perform duties safely
Stress Level: Low to Moderate

OSHA Classification:

Category III: Tasks that involve no exposure to blood, body fluids, or tissues, and Category I tasks are not a condition of employment.
The normal work routine involves no exposure to blood, body fluids, or tissues (although situations can be imagined or hypothesized under which anyone, anywhere might encounter potential exposure to body fluids). Persons who perform these duties are not called upon as part of their employment to perform or assist in emergency medical care or first-aid or to be potentially exposed in some other way. Tasks that involve handling implements or utensils, use of public or shared bathroom facilities or telephone, and personal contacts such as handshaking are Category III tasks.

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Denials and Appeals Coordinator

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