Denial Coordinator

Hamilton County Hospital District; Hamilton (TX); Vor Ort; USD 55.000 - 75.000; Vollzeit

Zusammenfassung

Hamilton County Hospital District is seeking an experienced Revenue Cycle Specialist to review, resolve, and track claim denials and appeals across hospital and clinic services. You will analyze variances, pursue recoveries, communicate findings to leadership, and work with clinical and administrative teams to prevent future denials.

This role requires knowledge of payer requirements, EOBs, and credentialed billings; proficiency with Excel, EHR systems, and payer portals; and the ability to

Qualifikationen

• Knowledge of hospital billing, payer requirements, EOBs and electronic remittance advice, claim adjustment and remark codes, and appeal processes.
• Proficiency with Excel, electronic health records, clearinghouse work queues, and payer portals.
• Ability to analyze trends, organize deadlines, document findings, and communicate effectively with clinical and administrative teams.

Aufgaben

• Review, resolve, and track assigned claim denials and appeals.
• Identify recurring denial causes and coordinate prevention efforts.
• Review payment variances against payer contracts; pursue recovery and report discrepancies.
• Work may include inpatient, swing bed, surgery, outpatient, ED, rural health clinic, and professional claims across payers.

Kenntnisse

Hospital billing knowledge

Payer requirements understanding

Analytical thinking

Communication skills

Deadline management

Ausbildung

High school graduate or equivalent

Associate degree or coursework in healthcare administration, business, medical billing, or related field

Tools

Excel

Electronic Health Records (EHR)

Clearinghouse queues

Payer portals

Jobbeschreibung

Responsible for timely review, resolution, and tracking of assigned claim denials and appeals;identification of recurring denial causes; and coordination of prevention efforts across the revenuecycle. Reviews assigned payment variances against approved payer contract terms andreimbursement methodologies, pursues appropriate recovery, and communicates unresolveddiscrepancies to leadership. Maintains accurate work queues and reports to support reimbursement,timely filing, and departmental improvement.Assigned work may include inpatient, swing bed, surgery, outpatient, emergency department, ruralhealth clinic, and professional claims across commercial and government payers. Leadershipestablishes written payer and service assignments, including ownership of appeals minus traditionalMedicare, clinical appeals, payment variances, and DNFB follow-up.A. Education High school graduate or equivalent required. Associate degree or coursework inhealthcare administration, business, medical billing, or a related field preferred.B. Job related skills Knowledge of hospital billing, payer requirements, EOBs and electronicremittance advice, claim adjustment and remark codes, and appeal processes. Proficiency with Excel,electronic health records, clearinghouse work queues, and payer portals. Ability to analyze trends,organize deadlines, document findings, and communicate effectively with clinical and administrativeteams.C. Licensure or certification None required. Relevant revenue cycle or billing certification preferred.Coding certification or clinical licensure is required only when separately assigned duties require thatqualification.D. Experience Minimum one year of hospital revenue cycle experience involving denials, appeals, orinsurance follow-up required; two or more years preferred. Experience with critical access hospitaland rural health clinic billing preferred. Independent complex appeals or contract analysisassignments require demonstrated competency and appropriate training.E. Physical and mental requirements Intermittent walking, sitting, and standing; occasionalbending, stooping, reaching, and lifting up to 20 pounds. Ability to concentrate, interpret detailedinformation, exercise judgment within assigned authority, and manage multiple deadlines. Duties maybe performed with reasonable accommodation.