Denial Management Coordinator

Midland Memorial Hospital; Midland (TX); On-site; USD 55,000 - 75,000; Full time

Job summary

Midland Memorial Hospital is seeking a Denial Management Coordinator to oversee the current appeals process and resolve contract variances on patient encounters. You will review denied claims, track denials, and collaborate with departments to develop prevention measures.

The role requires strong analytic, organizational, and communication skills, with experience in medical billing and knowledge of CMS/payor contracts. Monday–Friday, 8:00 AM–5:00 PM in Midland, TX.

Qualifications

• 5+ years medical billing office experience
• Strong analytic and problem-solving abilities
• Excellent organizational and prioritization skills
• Strong oral and written communication skills
• Proficient keyboard and 10-key data entry; Word, Excel, Access knowledge

Responsibilities

• Executes the denial appeals process, including receiving, assessing, documenting, tracking, responding to, and resolving appeals with third-party payers.
• Tracks the status and progress of denials and appeals
• Conducts internal and external correspondence accurately and professionally while following regulations
• Maintains data on types of claims denied and root causes; collaborates to propose improvements
• Prepares and submits reports as required
• Makes independent, complex decisions within the role's scope
• Identifies and resolves reimbursements and variance issues to resolve payment discrepancies
• Analyzes coding adjustments on EOB for accuracy and support
• Works with case management on denial trends and strategies to appeal
• Collaborates with contract variance team to verify denials against CMS/payor guidelines
• Develops denial prevention measures with hospital departments

Skills

Analytic skills

Organizational skills

Oral and written communication

10-key skills

Education

High school diploma or equivalency

Associate degree preferred

Tools

Word

Excel

Access

Job description

Job Description

The Denial Management Coordinator is responsible for managing the current appeals process at Midland Memorial Hospital. The coordinator will review denied claims and carry out the current appeals process while also resolving contract variances on patient encounters. Will identify denial trends and work collaboratively with various departments to develop prevention measures. Works to maintain third-party payer relationships, including responding to inquiries, complaints, and other correspondence. Knowledgeable of state/federal laws that relate to contracts and to the appeals process. Coordinator will work independently to process claims.

Shift and Schedule

Monday-Friday 8:00 AM - 5:00 PM

Essential Functions / Performance Expectations

• Executes the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party payers in a timely manner


• Tracks the status and progress of denials and appeals


• Conducts internal and external correspondence accurately, clearly, concisely, and professionally while following organizational regulations


• Maintains data on the types of claims denied and root causes of denials, and collaborates with team members to make recommendations for improvements and resolving issues


• Prepares, maintains, assists with, and submits reports as required


• Regularly makes complex decisions within the scope of the position, and is comfortable working independently


• Identifies and resolves reimbursements and variance issues to resolve payment discrepancies (e.g., denials, underpayments, etc.)


• Analyzes all coding adjustments made on EOB to determine payment accuracy and valid support


• Works directly with case management on denial trends and strategies to appeal successfully.


• Works collaboratively with contract variance team on denial trends they are seeing and verifying if the denials are valid according to current CMS/payor contract guidelines.


• Works with various departments in the hospital to develop denial prevention measures.

Education and Experience

• High school diploma or equivalency required


• Associate degree is preferred.


• Demonstrated technical knowledge.


• Analytic skills and the confident ability to make quick, effective decisions under pressure


• Strong organizational and prioritization skills.


• Strong oral and written communication skills.


• Must have acceptable keyboard and 10-key skills, along with strong knowledge of Word, Excel, Access, and other general computer expertise, or an equivalent combination of education and experience.


• 5+ years medical billing office experience

Physical Requirements

To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Stand, walk, sit, stoop, reach, lift, see, speak and hear.


• Lifting is limited to 35 lbs. for clinical staff and to 50 lbs. for non-clinical staff. The individual must use an assisted-lift device