Job Summary
The Denials & Appeals Coordinator is responsible for managing, tracking, and resolving denials and appeals to ensure timely reimbursement. This role requires in-depth knowledge of payer guidelines, systems, and requirements to navigate complex denial cases effectively, assist in issue resolution, and help identify trends that can improve claim outcomes.
Essential Functions
- Monitors assigned queues and duties across various systems (such as, Artiva, HMS, Hyland, BARRT) to ensure all follow-up dates are current.
- Analyzes denials to determine appropriate actions, completes appeals, or routes cases for clinical appeals as needed.
- Files and monitors appeals to resolve payer denials, documenting all activity accurately and maintaining logs, account notes, and system records.
- Maintains an up-to-date understanding of payer guidelines and requirements related to denials and appeals.
- Processes BARRT requests, reviews RAC/Government Audit accounts, and completes necessary rebills and adjustments.
- Identifies trends in denials to suggest improvements and reduce future claim issues, providing data for denial and appeal trends as needed.
- Performs other duties as assigned.
- Maintains regular and reliable attendance.
- Complies with all policies and standards.
Qualifications
- H.S. Diploma or GED required
- Associate Degree or higher in Health Information Management preferred
- 1-3 years of experience in medical billing, revenue cycle, or claims denials and appeals processing required
- Prior experience with revenue cycle processes in a hospital or physician office setting required
Knowledge, Skills and Abilities
- Strong knowledge of payer guidelines, medical billing practices, and appeal processes.
- Proficiency in relevant software and claim management systems, such as Artiva, HMS, Hyland, and BARRT.
- Excellent analytical skills for reviewing denial trends and suggesting improvements.
- Strong verbal and written communication skills to interact with payers and internal departments.
- Ability to prioritize tasks effectively and manage time in a fast-paced environment.
Licenses and Certifications
- Certified Revenue Cycle Specialist (CRCS) - AAHAM preferred