Denial Coordinator

Hamilton Healthcare System; Texas; Vor Ort; USD 55.000 - 75.000; Vollzeit

Zusammenfassung

Hamilton Healthcare System is seeking a Denials and Appeals Specialist to review, resolve, and track denials and appeals, identifying recurring causes and coordinating prevention across the revenue cycle.

The role involves analyzing variances against payer contracts and reimbursement methods, pursuing recovery, and communicating unresolved discrepancies to leadership, while maintaining queues and reports to support timely filing and departmental improvement.

Qualifikationen

• High school diploma or equivalent required; associate degree or coursework preferred.
• Knowledge of hospital billing, payer requirements, EOBs and remittance advice, claim adjustments, and appeals.
• Proficiency with Excel, electronic health records, clearinghouse work queues, and payer portals.
• Ability to analyze trends, organize deadlines, document findings, and communicate with teams.

Aufgaben

• Review, resolve, and track denials and appeals; identify recurring denial causes; coordinate prevention across revenue cycle.
• Review payment variances against payer contracts and methodologies; pursue recovery; inform leadership of unresolved discrepancies.

Kenntnisse

Hospital billing

Payer requirements

EOBs and remittance advice

Claim adjustments

Appeal processes

Excel

Electronic health records

Clearinghouse queues

Payer portals

Trend analysis

Deadline management

Documentation of findings

Communication with clinical teams

Ausbildung

High school diploma or equivalent

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

Tools

Excel

Electronic health records

Clearinghouse work 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 revenue
cycle. Reviews assigned payment variances against approved payer contract terms and
reimbursement methodologies, pursues appropriate recovery, and communicates unresolved
discrepancies 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, rural
health clinic, and professional claims across commercial and government payers. Leadership
establishes written payer and service assignments, including ownership of appeals minus traditional
Medicare, clinical appeals, payment variances, and DNFB follow-up.

Qualifications

• A. Education High school graduate or equivalent required. Associate degree or coursework in healthcare administration, business, medical billing, or a related field preferred.
• B. Job related skills 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.
• 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 that
  qualification.
• D. Experience Minimum one year of hospital revenue cycle experience involving denials, appeals, or
  insurance follow-up required; two or more years preferred. Experience with critical access hospital
  and rural health clinic billing preferred. Independent complex appeals or contract analysis
  assignments require demonstrated competency and appropriate training.
• E. Physical and mental requirements Intermittent walking, sitting, and standing; occasional
  bending, stooping, reaching, and lifting up to 20 pounds. Ability to concentrate, interpret detailed
  information, exercise judgment within assigned authority, and manage multiple deadlines. Duties may
  be performed with reasonable accommodation.