Denial Coordinator

Denial Coordinator

Holyoke Medical Center is in need of an experienced Denial Coordinator. Responsibilities include reviewing all denial accounts for categorization, level of appeal, and special requirements for initiating appeals. Create and maintain a clinical appeal process for all inpatient denials, ensuring that proper documentation is provided to support appeals of unauthorized inpatient days or days denied for lack of documentation. Create and maintain a clinical appeal process for outpatient denials where a referral was not obtained and clinical documentation is required. Utilizes denial reports to assess root causes and identify trends. Shares findings with stakeholders. Leads a Denials Management Stakeholders team, monitoring identified issues and process. Work with the highest level of appeal cases; refer appropriate cases to Physician Advisors and fiscal attorney. Coordinate all second level appeals that cannot be referred to attorney consultants. Coordinate timely processing of appeal at all levels.

Requirements: Qualifications/Requirements High School diploma equivalent required. Minimum of 3 years of related experience in a medical, hospital or healthcare-related environment with at least one year of experience in a hospital billing department. Experienced in healthcare claims processing preferred, knowledge of federal healthcare reimbursement systems a plus. Strong written and verbal communication skill. Excellence in Excel and Word. Strong analytical, organizational and time management skills required. Ability to learn quickly, build and maintain long term relationships and work with minimal supervision. Knowledgeable in FDCPA and MA FDCPA regulations.