Denial Management Coordinator

JOB SUMMARY

The Denial Management Coordinator serves as the primary point of contact for Memorial Healthcare and the Denial Management Team under the direct supervision of the Manager of Patient Financial Services. Will serve as a role model to all Memorial staff and must be able to problem solve and assist patients, customers, providers and staff. This position’s primary function is following up, processing and working all Denials that contributes to the Revenue Cycle.  Will exhibit excellent customer service skills, effective communication skills and be a mentor and leader for all staff. 

Strives for superior performance by consistently providing a product or service to leadership and staff that is recognized as ultimately contributing to the patient and family experience.  Recognizes and demonstrates understanding of patient and family centered care. 

PRIMARY JOB RESPONSIBILITIES

1. Applies excellent customer service skill.
2. Maintains confidentiality of all information at all times.
3. Maintains operating instructions and keeps staff updated and educated.
4. Completes work within authorized time to assure compliance.
5. Daily work denied claims identified in Expanse through Denial Management or by denials identified through 835 payment files in Quadax or other available programs or reports.
6. Critical thinking with the ability to validate the accuracy of the denial in accordance with insurance contracts and billing policies.
7. Demonstrates the ability to determine correctness of charges and coding.
8. Secure needed medical record documentation required by or requested by insurance companies when necessary to submit with claims.
9. Work with, when necessary, the Authorization/Benefits/Verification specialists Team to obtain proper authorizations for services
10. Report denial trends identified to Revenue Integrity, Patient Financial Services Manager and Revenue Cycle Director.
11. Work closely with Revenue Integrity Department in identifying payment issues based on contracts
12. Effectively disburse information to Patient Financial Services Manager and Director of Revenue Cycle to enable education around denials and solutions to reduce the number of denials.
13. Work with other departments regarding coding or charge issues related to claims.
14. Attend or participate in webinars/seminars concerning billing and reimbursement changes.
15. Work with patients when needed to obtain resolution of accounts.
16. Must be able to work effectively with others and complete tasks within specified or given deadlines.
17. Demonstrates knowledge of and supports hospital mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality statements, corporate compliance plan, customer service standards, and the code of ethical behavior.

DEPARTMENTAL AND ADDITIONAL JOB RESPONSIBILITIES

1. Other duties as assigned

JOB SPECIFICATIONS

EDUCATION

1. Associates degree preferred.
2. High school diploma or equivalent is required.
3. Post high school courses in medical billing, medical terminology is preferred,

EXPERIENCE

1. Minimum of 3 years’ experience working in a professional environment
2. Minimum of 3 years’ experience working  in Denial Management within a facility or professional practice.
3. PC experience required
4. Use of multi-line phone experience required
5. Office Procedures required.
6. Customer Service experience required
7. Previous experience as a manager, team lead or trainer – required
8. Open , honest and tactful communication skills

ESSENTIAL PHYSICAL ABILITIES/MOTOR SKILLS

1. Able to travel independently throughout all Memorial Healthcare facilities.
2. Small motor skills required for operating modern computer, office, and telephone equipment as utilized by Memorial Healthcare (MHC).
3. Ability to sit or stand for periods of time.
4. Ability to work alone.
5. Ability to give and receive accurate information through speaking and listen.

ESSENTIAL TECHNICAL ABILITIES

1. Proficiency using modern office, computer and telephone equipmentas used by Memorial Healthcare.
2. Ability to enter and retrieve data from computer.
3. Ability to pull required reports, updates and event notifications.
4. Ability to work with or maintain the phone directory.
5. Works with the IS and Maintenance teams to keep technology and tools functional.
6. Detail Oriented.

ESSENTIAL MENTAL ABILITIES

1. Ability to adapt and maintain focus in fast paced, quickly changing or stressful situations.
2. Ability to read and interpret a variety of documents including, but not limited to policies, operating instructions, white papers, regulations, rules and laws.
3. Ability to perform required switchboard functions.
4. Ability to learn scheduling procedures for all routine physician office appointments and expand those when needed.
5. Ability to perform simple accounting functions.

ESSENTIAL SENSORY REQUIREMENTS

1. Able to see for the purpose of reading information received in formats including but not limited to paper, computer, reports, bulletins, updates, manuals.
2. Able to hear for work-related purposes.
3. Ability to communication receptively and expressively in English both written and spoken, with employees, physicians, volunteers and patients.
4. Ability to maintain self-control.
5. Ability to listen respectfully to direct phone calls appropriately.

INTERPERSONAL SKILLS

1. Ability to interact with co-workers, hospital staff, administration, patients, physicians, the public and all internal and external customers in a professional and effective, courteous and tactful manner, at all times, physically, verbally and in all written and electronic communication.
2. Required to remain calm when adversity is encountered.
3. Open, honest, and tactful communication skills.
4. Ability to work as a team member in all activities.
5. Positive, cooperative and motivated attitude.