DENIALS MANAGMENT COORDINATOR

Denials Management Coordinator - Revenue Integrity

Description:

Responsible for developing, implementing and managing a centralized program to promote greater efficiency with completing, tracking, and reporting coding and retro audit reviews to determine the appropriate appeal of patient accounts.

Combines clinical, business, and regulatory knowledge and skill to reduce significant financial risk and exposure caused by denial and audit of claims billed for rendered services.

Through continuous assessments, problem identification, and education, this individual facilitates the quality of health care delivery in areas of inpatient coding, DRG, outpatient, professional coding, medical necessity, government, and commercial payer requirements.

Furthermore, the individual routinely analyzes data related to payer audit and denial trends specific to coding-denial and takeback concerns.

This position works closely with HIM and CDI as well as key stakeholders across Revenue Cycle.

Responsibilities:

• Reviews and analyzes current audit information to identify opportunities for improvement internally and payers.
• Maintains reporting specific to audit statuses, identifying internal and payer patterns to better manage payer issues proactively.
• Update and maintain audit tracking spreadsheets outside of RAC software.
• Develop and maintain procedural documentation.
• Identify and resolve system and payer issues that result in payment delays, incorrect payments.
• Service as a PFS, PAS, HIM, Compliance, Contract Management, Clinical Liaison to third party payers, and other parties in a problem-solving or information capacity.
• Monitor deadlines and ensure all parties meet timely filing for appeal deadlines.
• Assist with auditing involving any third-party commercial payer.
• Participate in payer meetings to discuss appeal progress and identify trends with payer processing appeals to resolve cases.
• Establish and enforce internal audit policies including pre-payments audits.
• Collect and analyze data from audits and concurrent reviews to identify recurring problems.
• Acts as a coordinator and mentor to RID Denial Staff.

Education/Experience:

Minimum of an Associate’s Degree in Business, Paralegal Studies, Coding, Healthcare, or related field.

Two (2) years of relevant experience in Compliance, Coding, HIM, Insurance denials, or Legal experience may be considered in lieu of an Associate’s degree

Minimum three (3) years’ experience within the healthcare field performing any variety of organizational, administrative, or process improvement functions.

Preferred experience:

Experience in compliance, coding, insurance denials, and/or a legal setting.

Experience or background in denials management.

Experience working with 3^rd party payers.

Licenses/Certifications: None Required

Required Skills, Knowledge, and Abilities:

• Excellent oral and written communication skills.
• Establish and maintain professional and cooperative relationships.
• Efficient and effective analytical skills.
• Ability to research regulatory requirements.
• Effective human relations abilities.
• Proficiency with Microsoft applications and other applicable software and database management applications.
• Effective problem-solving abilities.
• Strong ability to effectively collaborate alliances and promote teamwork.

Perks/Benefits:

(for eligible employees):

Have optimal opportunity for career growth within our growing organization

Medical / Dental

Retirement Plan

PTO and paid life insurance  

What Sets Us Apart

Archbold Medical Center is a four-hospital, four-nursing-home health system with 540 patient beds. We employ more than 2,500 people and boast an outstanding medical staff of nearly 200 qualified physician specialists. Our flagship hospital, Archbold Memorial Hospital, is a 264-bed hospital located in Thomasville, Georgia. Our system hospitals, also in Georgia, are Archbold Brooks Hospital in Quitman, Archbold Grady Hospital in Cairo, and Archbold Mitchell Hospital in Camilla.

For nearly 100 years, Archbold has been synonymous with high-quality, compassionate medical care. While our exemplary facilities have helped us maintain an excellent reputation, our team members are what makes Archbold special. 

You are unique. You have skills and a strong passion for helping people. You also have personal goals, and Archbold wants to help you achieve them. We are a diverse healthcare system that promotes teamwork, continuing education, and leadership, and we are committed to recruiting and retaining the best healthcare professionals to join our Archbold team. 

What we offer:

We know that your time and expertise are valuable, and to help our employees be at their best and make the most of their employment experience, we offer a comprehensive and generous benefits package that helps our employees and their families meet the challenges of everyday living.

We strive to be a workplace of choice, and from high-quality medical and dental care benefits to retirement benefits that help build wealth for your future, Archbold is proud to offer our employees one of the best benefits packages in the area.

Below are a few of the benefits Archbold Medical Center offers to employees:

• Work/Life Balance
• Planning for the Future
• Low-Cost Prescriptions
• Health & Wellness Benefits
• Planning for Life’s Unexpected Moments
• Helping You to Advance Your Career

Mission

To provide safe, innovative and compassionate care for our communities.

Vision

A healthier region, stronger communities, meaningful work, and trusted care