What are the responsibilities and job description for the Denial Coordinator - Case Management Department - Casual Status position at IRMC?
In this role you will be:
- Facilitating managed care denials/inquiries and forwarding them to the next level of management.
- Processing appeals for mailing.
- Coordinating Medicare, Medical Assistance, and managed care denials/inquiries.
- Coordinating the process to ensure deadlines are met.
- Working closely with contracted physician advisors for appeal and denial management.
- Entering data into the appropriate software programs for reporting purposes, and presenting data and statistics to physician office meetings.
- A member of teams such as the forms committee, audit team, revenue cycle, RAC committee, and mental health networking group.
- Maintaining separate records for various audit contractors.
- Preparing all reports and data for UM committee and as they pertain to the Case Management Department.
- Responsible for keeping staff up to date on payor policies and procedures, and demonstrating familiarity with managed care and third-party payor systems.
- Serving as a resource to staff regarding denials and appeals.
- Facilitating the denial process until final outcomes are received for each case.
- Reviewing daily scheduling and outpatient records to identify precertification issues and notifying the appropriate personnel.
- Serving as a liaison between the medical center and external business partners.
- Working with internal and external customers to remain up-to-date on standards and processes.
- Responsible to address tasks and outstanding items that may impact billing in a timely manner.
- Participates in required meetings to share pertinent data.
Qualifications
- EDUCATION: High school graduate/degree or diploma in a health-related field
- EXPERIENCE:
- Secretarial experience working with managed care in a healthcare setting
- Denials/appeals coordination as well as experience with software including, but not limited to, Davinician, Optum, HER, Challenger. Preferred experience with Excel, word and power point.
- Minimum 3 years clinical experience in an Emergency Department, Critical Care, Cath Lab, or related hospital setting
- Basic computer skills and office equipment experience
