Company Overview
Surgical Associates, SC is a leading independent surgical group serving multiple communities across the region. With a team of highly skilled surgeons specializing in various fields, we are dedicated to providing exceptional surgical care through our clinics and affiliated surgical centers.
Summary
The Denial Coordinator is responsible for reviewing and resolving denied insurance claims to maximize reimbursement and ensure accurate payment for services rendered. This role investigates denial reasons, corrects claim errors, submits appeals, and works closely with insurance companies, providers, and billing staff to achieve timely claim resolution. The Denial Coordinator also monitors denial trends and recommends process improvements to reduce future claim denials and strengthen overall revenue cycle performance.
Essential Job Functions
· Reviews and analyzes insurance claim denials to determine the root cause and appropriate corrective action.
· Investigates denied claims for coding errors, missing documentation, authorization issues, or payer-specific requirements.
· Corrects claim errors and resubmits claims to insurance carriers in a timely manner.
· Prepares and submits written appeals for denied or underpaid claims, including supporting documentation as required.
· Communicates with insurance companies regarding claim status, denials, appeals, and reimbursement issues.
· Tracks and monitors denied claims to ensure timely follow-up and resolution.
· Identifies denial trends and provides recommendations to management to improve claim acceptance rates and reduce future denials.
· Collaborates with providers, coders, clinical staff, and revenue cycle team members to resolve billing and reimbursement issues.
· Maintains accurate records of denial activity, appeal outcomes, and payer communications.
· Assists with special projects, audits, reporting, and other revenue cycle functions as assigned.
· This list is not inclusive of all duties and responsibilities that may be assigned. They are only listed as typical. Any other duties and responsibilities assigned will be of a similar nature requiring the same relative skill and capabilities.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience
· High school diploma or equivalent is required.
· Associate's or Bachelor's degree in Healthcare Administration, Business Administration, Medical Billing and Coding, or related field is preferred.
· Minimum of two (2) to four (4) years of experience in medical billing, insurance claims processing, denial management, or a related healthcare revenue cycle role.
· Previous experience working with insurance appeals, reimbursement processes, and claim resolution is preferred.
· Experience working with Epic software or other Electronic Health Record (EHR) systems is preferred.
· Understanding of medical terminology, insurance regulations, and payer guidelines is required.
· Experience working with Epic software is preferred.
Competencies
· Demonstrates strong knowledge of medical billing, denial management, reimbursement processes, and insurance claims.
· Possesses working knowledge of ICD-10 diagnosis coding, CPT procedure coding, and payer-specific billing requirements.
· Demonstrates strong analytical and problem-solving skills with the ability to identify root causes of claim denials.
· Maintains a high level of attention to detail and accuracy.
· Possesses strong written communication skills for preparing professional appeal letters and supporting documentation.
· Demonstrates effective verbal communication and interpersonal skills when interacting with insurance representatives, providers, and staff.
· Proficient in Microsoft Office applications and healthcare information systems.
· Ability to manage multiple priorities, meet deadlines, and work independently in a fast-paced environment.
· Adheres to strict confidentiality standards and maintains compliance with HIPAA regulations.
· Demonstrates professionalism, accountability, and a commitment to revenue cycle excellence.
Physical/Mental Demands and Work Environment
The nature of the job requires sitting for extended periods of time. While performing the essential functions of the job one may occasionally walk, stand, bend/stoop, squat, push/pull. Some lifting/carrying up to10 lbs. is required. The use of hands for repetitive simple grasping is required. While performing the job, one will encounter continuous close paperwork, use of computer monitor, and frequent need for color vision, visual monotony. Must utilize hearing for occasional conversations, telephone use, background noise. The job requires occasional independent decision-making.
This job description is not a guarantee of employment. It is understood that employment is “at will,” and the employer or the employee may terminate employment at any time.
Pay: From $20.00 per hour
Benefits:
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Application Question(s):
- How did you hear of this opportunity?
Location:
- Wausau, WI 54401 (Preferred)
Ability to Commute:
- Wausau, WI 54401 (Required)
Work Location: In person
