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

Paycom - ATS; Reno (OH); On-site; USD 55,000 - 75,000; Full time

Job summary

Memorial Health System seeks a Denials Management Coordinator to review hospital denials, identify patterns, and educate staff on proper processes. The role requires concise appeal writing and clear communication with insurance payers while documenting results in the HIS.

You will contribute to monthly audit reports, provide recommendations for reducing future denials, and collaborate across departments to optimize denial management and revenue integrity.

Qualifications

• High School Diploma or GED required.
• Minimum 2 years of healthcare-related experience.
• Experience with coding, medical terminology, and denials preferred.
• Coding knowledge (ICD-10) preferred; certification within 2 years may be required.

Responsibilities

• Analyze all denials for patterns and trends.
• Educate front line staff on proper denial processes.
• Verbalize with insurers and write appeal details for payment on denials.
• Document denial reviews in the hospital information system.
• Prepare management reports on audit results and process improvements.
• Make monthly observations and recommendations to prevent denials.

Skills

Analytical skills

Negotiation skills

Communication skills

Team orientation

Computer skills

Education

High School Diploma or GED

2 years healthcare experience

ICD-10 knowledge

Coding certification within 2 years

Tools

Payment review systems

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.