Denials Management Coordinator - Denials Management - FT 1.0 (80 hrs biweekly)

Memorial Health System (Ohio); Reno (OH); On-site; USD 60,000 - 80,000; Full time

Job summary

Memorial Health System (Ohio) seeks a Denials Management Coordinator to analyze denial patterns and educate frontline staff on proper processes. You will articulate appeal details to insurers and document results in the hospital system, while preparing management reports on audits and systemic errors.

The role includes monthly prevention observations and other duties as needed. The position emphasizes strong analytical skills, negotiation abilities, and proficiency with payor and hospital coding

Qualifications

• HS Diploma or GED required.
• Minimum of two years of healthcare-related experience required.
• Experience in coding, medical necessity, registration, insurances and precertification processes and/or denials preferred.
• 2+ years of experience or formal education in ICD10 coding, medical terminology, anatomy/pathophysiology and disease process preferred.
• Coding certification within 2 years of hire may be required depending on experience.

Responsibilities

• Analyzes all denials for patterns.
• Works with front line staff and educates on proper processes.
• Verbalizes to insurance carriers and writes appeal details to support additional payment on denied claims.
• Documents results of all denial reviews in the hospital information system.
• Prepares reports on audit results, process improvement recommendations and systemic payment errors.
• Makes monthly observations and recommendations to prevent future denials.
• Assumes other duties and responsibilities as necessary.

Skills

Analytical skills

Negotiation skills

Computer skills

Oral and written communication

Team collaboration

Medical records and billing knowledge

Education

HS Diploma or GED

ICD-10 coding / medical terminology knowledge

Tools

Hospital information systems

Coding methodologies

Job description

In an environment of continuous quality improvement, the Denials Management Coordinator is responsible for reviewing all denials to determine patterns in errors, payors, and internal processes to improve our denial rate. Exhibits the MHS Standards of Excellence and exercises strict confidentiality at all times.Job Functions:Analyzes all denials for patterns.Works with front line staff and educate on proper processes.Ability to verbalize to insurance carriers and write appeal details to support additional payment on denied claims.Accurately and consistently documents the results of all denial reviews in the hospital information system.Prepares reports as required by management regarding audit results, process improvement recommendations and systemic payment errors.Makes monthly observations and recommendations to prevent future denials.Assumes all other duties and responsibilities as necessary.Minimum Education/Experience Required:High School Diploma or GED required.Minimum of two years of previous experience in a healthcare-related position required.Experience in coding, medical necessity, registration, insurances, and precertification processes and/or denials preferred.Minimum of 2 years of experience or formal education in basic ICD10 coding, medical terminology, Anatomy/pathophysiology, and disease process preferred.Depending on healthcare-related experience, may require coding certification within 2 years of date of hire. Experience reviewing ambulatory claim denials preferred.Special Knowledge, Skills, Training:Computer skills (word processing, spreadsheet, graphics, and database software applications).Strong quantitative, analytical and organization skills.Strong negotiation skills.Proficient in payment review systems, hospital information systems and coding methodologies.Ability to understand medical records, hospital bills, and the charge master.Ability to understand all ancillary department functions for the facility.Ability to understand complex insurance terms and payment methodologies.Ability to effectively negotiate with insurance carriers and customers.Ability to utilize and understand computer technology.Ability to communicate orally and in written form.Team-orientated with strong interpersonal skills.Compensation Details: Education, experience, and tenure may be considered along with internal equity when job offers are extended.Benefits: Memorial Health System is proud to offer an affordable, comprehensive benefit package to all full time and flex time employees. To learn more about the many benefits we offer, please visit our website at www.mhsystem.org/benefits.Bonus Eligibility: Available to qualifying full or flex time employees. Eligibility will be determined upon offer.Memorial Health System is an equal opportunity provider and employer.If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at https://www.ocio.usda.gov/document/ad-3027, or at any USDA office, or call [phone] to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W., Stop 9410, Washington, D.C. 20250-9410, by fax [phone] or email at [e-mail].* Memorial Health System is a federal drug-free workplace. This policy prohibits marijuana use by employees.