Utilization Management Coordinator

In an environment of continuous quality improvement, the Denials Management Coordinator is responsible for reviewing all denials to determine patterns in errors, payors, and internal processes to improve our denial rate. Exhibits the MHS Standards of Excellence and exercises strict confidentiality at all times.Job Functions:Analyzes all denials for patterns.Works with front line staff and educate on proper processes.Ability to verbalize to insurance carriers and write appeal details to support additional payment on denied claims.Accurately and consistently documents the results of all denial reviews in the hospital information system.Prepares reports as required by management regarding audit results, process improvement recommendations and systemic payment errors.Makes monthly observations and recommendations to prevent future denials.Assumes all other duties and responsibilities as necessary.Minimum Education/Experience Required:High School Diploma or GED required.Minimum of two years of previous experience in a healthcare-related position required.Experience in coding, medical necessity, registration, insurances, and precertification processes and/or denials preferred.Minimum of 2 years of experience or formal education in basic ICD10 coding, medical terminology, Anatomy/pathophysiology, and disease process preferred.Depending on healthcare-related experience, may require coding certification within 2 years of date of hire. Experience reviewing ambulatory claim denials preferred.Special Knowledge, Skills, Training:Computer skills (word processing, spreadsheet, graphics, and database software applications).Strong quantitative, analytical and organization skills.Strong negotiation skills.Proficient in payment review systems, hospital information systems and coding methodologies.Ability to understand medical records, hospital bills, and the charge master.Ability to understand all ancillary department functions for the facility.Ability to understand complex insurance terms and payment methodologies.Ability to effectively negotiate with insurance carriers and customers.Ability to utilize and understand computer technology.Ability to communicate orally and in written form.Team-orientated with strong interpersonal skills.Compensation Details: Education, experience, and tenure may be considered along with internal equity when job offers are extended.Benefits: Memorial Health System is proud to offer an affordable, comprehensive benefit package to all full time and flex time employees. To learn more about the many benefits we offer, please visit our website at Eligibility: Available to qualifying full or flex time employees. Eligibility will be determined upon offer.Memorial Health System is an equal opportunity provider and employer.If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at or at any USDA office, or call View phone number on click.appcast.io to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W., Stop 9410, Washington, D.C. 20250-9410, by fax View phone number on click.appcast.io or email at View email address on click.appcast.io Health System is a federal drug-free workplace. This policy prohibits marijuana use by employees. #J-18808-Ljbffr