Denials Management Coordinator - On-site
- Lewiston, ME
- Permanent
- Full-time
- Triaging incoming variance inventory
- Validating appeal criteria is met in compliance with departmental policies and procedures
- Composing technical denial language for reconsideration, including both written and telephonic
- Ensuring high level of competence in process and payer knowledge to overcome objections that
- Gaining commitment for payment through concise and effective appeal composition
- Identifying problem accounts/processes/trends and escalate as appropriate
- Utilizing effective documentation standards that support a strong historical record of actions taken
- Resolving the account (posting correct contractual adjustments, posting other non-cash related
- Submitting uncollectible claims for adjustment timely and correctly
- Resolving claims impacted by payer recoupments, refunds, and posting errors
- Meeting and maintaining established departmental performance metrics for production and quality
- Maintaining working knowledge of workflow, systems, and tools used in the department
- Practicing and adhering to the Code of Conduct philosophy and Mission and Value Statement
- Maintaining collaborative approach to problem solving working with other revenue cycle teams
- Other duties as assigned
- Resolving accounts to 0 insurance balance
- Completes appropriate actions needed for an effective appeal including conducting authorization
- Utilizes systems, various documents and reports to identify and correct errors accurately and
- Escalates issues as appropriate.
- Corresponds with third party payers, hospital departments, and patients to obtain information
- Releases information following Federal, State and Hospital guidelines.
- Uses assigned work queues and prioritization standards and guidelines to perform denial resolution
- Uses reference material to troubleshoot payer issues and increase understanding of denial
- Reference payer websites as needed.
- Analyzes and researches the denial reasons for each assigned denial code. Determines and executes
- Follows payers established procedures and timelines to submit appeals utilizing payers preferred
- Documents all actions taken during the denial resolution process clearly including actions taken,
- Adjusts account balances using correct transaction code adhering to established departmental
- Follows established protocols to ensure all documents are retained appropriately Meets established
- Facilitates and promotes the sharing of knowledge and content throughout departments.
- Follows all established Hospital Billing Revenue Cycle Management departmental and
- Participates in cross training of billing resources.
- Demonstrates excellent attendance and actively participates in a variety of meetings and training
- Maintains and fosters an organized, clean, and safe work environment.
- Contributes to the development and application of process improvements.
- Practices cost containment and fiscal responsibility through the efficient use of supplies,
- Complies with established departmental policies, procedures and objectives.
- Attends variety of meetings, conferences, seminars as required or directed.
- Demonstrates use of Quality Improvement in daily operations.
- Complies with all health and safety regulations and requirements.
- Respects diverse views and approaches, and contributes in maintaining an environment of
2. Six or more years of experience in health care billing functionsKnowledge, Skills and Abilities:
- Ability to perform assigned tasks efficiently and in timely manner.
- Ability to work collaboratively and effectively with people.
- Exceptional communication and interpersonal skills.
- Demonstrates ability to organize
- Perform and track multiple tasks accurately in short timeframes
- Able to work quickly and accurately in a fast-paced environment while managing multiple demands
- Able to work both independently and collaboratively as a team player
- Demonstrates adaptability, analytical and problem-solving skills
- Attention to detail
- Ability to engage patients and team members utilizing the CMH Experience Standards
ii. I am actively listening and seeking information
iii. I am honest, truthful, and consistent
iv. I am respectful, treating all individuals with dignity and empathy
v. I am serving as a role model, taking both initiative and ownership when appropriate
vi. I am working collaboratively and demonstrating teamwork
vii. I am resilient and adapt to change in positive ways.
- Demonstrated ability to direct and triage in a highly fluid dynamic operational environment.
- Ability to collaborate with all layers of the management/ administration team.