Denials Coordinator (4835)

Position Summary:

The Denials Coordinator is responsible for coordinating, monitoring, and supporting denial prevention and resolution activities across the healthcare system, including hospital and professional billing operations.

This position serves as a central resource for identifying denial trends, analyzing root causes, coordinating corrective actions, and facilitating collaboration among revenue cycle departments, clinical teams, and third-party payers.

The Denials Coordinator works closely with Patient Access, Precertification and Authorizations, Health Information Management (HIM), Coding, Clinical Documentation Integrity (CDI), and Patient Financial Services to reduce preventable denials, minimize avoidable write-offs, improve reimbursement, and accelerate cash collections.

The position supports the organizations Integrated Revenue Cycle model by promoting shared accountability, process standardization, and continuous performance improvement.

Key Responsibilities:

• Denials Management and Coordination

• Coordinate daily denial management activities across hospital and professional billing operations.

• Monitors denied claims to identify trends, recurring issues, and opportunities for improvement.

• Facilitate timely resolution of denied claims through collaboration with billing, coding, authorization, and clinical departments.

• Identify high-dollar, high-volume, and recurring denials requiring additional investigation or escalation.

• Assist with the development and implementation of standardized denial management workflows.

• Monitor denial aging and appeal deadlines to minimize timely filing losses.

• Coordinate with internal departments and external payers to resolve complex reimbursement issues.

• Denial Prevention and Root-Cause Analysis

• Conduct root-cause analysis to identify operational, technical, clinical, and payer-related causes of denials.

• Identify preventable denials related to registration, eligibility, authorizations, medical necessity, documentation, coding, and billing.

• Work collaboratively with departmental leadership to develop corrective action plans.

• Monitor the effectiveness of implemented process improvements.

• Identify opportunities to improve first-pass claim acceptance and reduce rework.

• Support proactive denial prevention strategies throughout the revenue cycle.

• Integrated Revenue Cycle Collaboration

• Serve as a liaison between Patient Access, Authorizations, HIM, Coding, CDI, Hospital Billing, and Professional Billing.

• Facilitate communication and coordination between departments to address denial trends and reimbursement barriers.

• Participate in interdisciplinary denial review meetings and payer-specific workgroups.

• Promote shared responsibility for denial prevention and timely account resolution.

• Support standardized denial management practices across hospital and physician billing teams.

• Assist leadership in identifying opportunities for cross-training and workflow improvements.

• Appeals and Payer Relations

• Coordinate the appeals process to ensure timely submission, appropriate documentation, and effective follow-up.

• Collaborate with coding, clinical, and billing staff to obtain supporting documentation for appeals.

• Monitor payer appeal requirements, deadlines, and reimbursement policies.

• Track appeal outcomes to identify successful strategies and opportunities for improvement.

• Assist with escalation of unresolved or recurring payer issues to revenue cycle leadership and Managed Care.

• Support payer meetings by preparing denial trends, examples, and supporting data.

• Reporting and Performance Improvement

• Prepare and maintain denial management reports, dashboards, and performance summaries.

• Monitor key performance indicators, including:

• Initial and final denial rates.

• Denial dollars by payer, category, and department.

• Appeal submission and overturn rates.

• Denial aging and resolution time.

• Avoidable write-offs.

• Denial recovery and cash collections.

• Identify trends and present findings and recommendations to revenue cycle leadership.

• Assist in developing departmental goals and monitoring progress toward established performance targets.

• Support ongoing process improvement initiatives designed to strengthen financial performance.

• Compliance and Quality Assurance

• Ensure denial management activities comply with applicable federal and state regulations, payer requirements, and organizational policies.

• Maintain knowledge of Medicare, Medicaid, commercial insurance, and managed care reimbursement requirements.

• Support accurate documentation and appropriate handling of payer disputes and appeals.

• Identify potential compliance concerns and escalate them to appropriate leadership.

• Maintain confidentiality and adhere to HIPAA and organizational privacy requirements.

• Education and Process Improvement

• Provide feedback and education to revenue cycle departments regarding common denial causes and prevention opportunities.

• Assist with developing standardized procedures, reference materials, and training resources.

• Communicate payer policy changes affecting reimbursement and denial management.

• Participate in system optimization, automation, and technology improvement initiatives.

Licenses and Certifications Required:

• None

Educational Requirements:

• Associate degree in Healthcare Administration, Business Administration, Health Information Management, or related field preferred. Equivalent combinations of education and relevant healthcare revenue cycle experience may be considered.

Experience Requirements:

• Minimum of 3 years of healthcare revenue cycle experience, preferably in billing, denials management, authorizations, coding, or insurance follow-up.
• Experience working with Medicare, Medicaid, and commercial insurance payers.
• Experience in a hospital or integrated healthcare system preferred.
• Prior experience with denial reporting, appeals, or process improvement strongly preferred.

Special Skills or Training Requirements:

• Strong understanding of hospital and professional billing processes.
• Knowledge of payer reimbursement methodologies, claim denials, appeals, and timely filing requirements.
• Ability to analyze denial trends and identify operational root causes.
• Strong organizational, analytical, and problem-solving skills.
• Excellent written and verbal communication skills.
• Ability to collaborate effectively with clinical, financial, and operational departments.
• Proficiency with electronic health records, billing systems, Microsoft Excel, and reporting tools.
• Ability to prioritize multiple assignments and meet established deadlines.
• Detail-oriented with a strong commitment to accuracy, accountability, and follow-through.
• Ability to work independently while supporting team-based initiatives.
• Key Performance Expectations - The Denials Coordinator is expected to contribute to measurable improvements in: Reduction of preventable claim denials; Reduction in avoidable administrative write-offs; Increased appeal success and reimbursement recovery; Improved denial resolution turnaround times; Reduced denial-related accounts receivable; Improved first-pass claim acceptance; Increased collaboration and accountability across revenue cycle departments; Improved cash flow through timely denial identification and resolution.
• Scope of Responsibility - The Denials Coordinator functions as an operational coordination and performance improvement resource within the Integrated Revenue Cycle. The position does not ordinarily have direct supervisory responsibilities but is expected to coordinate activities across multiple departments, facilitate problem resolution, and provide actionable recommendations to departmental leadership. The position works under the direction of revenue cycle leadership and may be assigned special projects involving payer performance, denial prevention, revenue recovery, and operational improvement.

Physical Requirements:

This role involves prolonged periods of computer-based work, including extensive keyboarding, data analysis, and electronic documentation review. The position requires sustained attention to detail, repetitive hand movements, and the ability to remain seated for extended durations. Occasional movement or stretching may be needed to maintain ergonomic comfort and productivity.

Environmental Requirements:

Frequent interaction with billing, coding, clinical, administrative, and financial personnel. Requires extended periods of computer-based work and data analysis. The position is performed in an office environment that supports detail-oriented tasks and secure handling of sensitive patient information.