Denial Coordinator

Hamilton County Hospital District; United States; On-site; USD 55,000 - 75,000; Full time

Job summary

Hamilton County Hospital District is seeking a Denials and Appeals Specialist to review, resolve, and track assigned claim denials and appeals across commercial and government payers. You will identify recurring denial causes, coordinate prevention efforts with revenue cycle teams, and ensure accurate reporting to leadership.

Minimum one year in hospital revenue cycle with denials required; associates preferred.

Qualifications

• High school graduate or equivalent required; associate degree or coursework in healthcare administration, business, medical billing or related field preferred.
• 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.

Responsibilities

• Review denied claims and appeals and track resolution; identify recurring denial causes and coordinate prevention across the revenue cycle.
• Review assigned payment variances against payer contract terms and reimbursement methodologies, pursue recovery, and communicate unresolved discrepancies to leadership.
• Maintain accurate work queues and reports to support reimbursement, timely filing, and departmental improvement.
• Assignments may include inpatient, swing bed, surgery, outpatient, ED, rural health clinic, and professional claims across commercial and government payers; leadership defines payer/service assignments.

Skills

Hospital billing

Payer requirements

Remittance advice

Claim adjustment codes

Appeals process

Excel

EHR systems

Clearinghouse software

Payer portals

Trend analysis

Deadline management

Cross-functional comms

Education

High school diploma

Associate degree in healthcare administration

Tools

Clearinghouse software

Payer portals

Job description

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.