Healthcare Denials & Appeals Analyst

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

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.