Denials Management Coordinator - Denials Management - FT 1.0 (80 hrs biweekly) (70831)

Memorial Health System - Ohio; Reno (OH); On-site; USD 52,000 - 76,000; Full time

Job summary

Memorial Health System - Ohio in Reno, OH is seeking a Denials Management Coordinator to review denials, identify patterns, and work with front-line staff to improve denial rates. You will document findings in the hospital information system and prepare management reports on denial trends.

The role requires a HS diploma or GED and at least two years in a healthcare-related position, with experience in coding, medical necessity, and payer communications preferred.

Qualifications

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

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 denial reviews in the hospital information system.
• Prepares reports for management regarding audit results and process improvement recommendations.
• Makes monthly observations and recommendations to prevent future denials.
• Assumes all other duties as necessary.

Skills

Quantitative analysis

Analytical thinking

Organization skills

Negotiation skills

Communication with insurers

Medical records understanding

Education

High School Diploma or GED

2 years healthcare-related experience or ICD-10 knowledge

Coding certification within 2 years of hire (if applicable)

ICD-10 coding basics knowledge

Tools

Hospital information systems

Coding methodologies

Payment review systems

Job description

Job Details

Job Location: Reno, OH 45773Position Type: Full TimeJob Shift: 8-Hour Day ShiftJob Category: Service Support

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.

QualificationsMinimum 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.