Denial and Reimbursement Coordinator (3547)

Job Summary - 

The primary responsibility of the Denial and Reimbursement Coordinator is to manage and resolve denied claims and claims processes, including underpaid claims to ensure timely reimbursement and optimal revenue flow for the organization. This role requires a detailed understanding of:

o Insurance policies

o Coding practices

o Appeals processes

o Relevant regulations and tools to drive payment integrity with payers and plans

The coordinator will work closely with the PFS manager healthcare providers, insurance companies, and internal teams to identify denial trends and underpayments, implement corrective actions, and enhance overall claims management processes. The Denials and Reimbursement coordinator reports directly to the Manager of Patient Financial Services.

Regulatory Requirements

· Minimum Education Required: High School graduate or GED.

· Ability to work with internal and external departments in a collaborative manner.

· A minimum of 2 years of related healthcare Revenue Cycle experience, preferably with a focus on denials and reimbursement.

· Strong understanding of healthcare billing, coding and reimbursement processes.

· Experience with Meditech EMR system strongly preferred.

· Relevant certifications (e.g., Certified Revenue Cycle Professional (CRCP), Certified Professional Coder (CPC)) are a plus.

Language Skills

· Ability to communicate in English, both verbally and in writing.

· Additional languages preferred.

· Excellent interpersonal skills.

Physical Demands

• Physical posture: Primarily sedentary; sitting for prolonged periods. Occasional standing and walking throughout unit/office to retrieve records, deliver documents, or meet.
• Mobility: Ability to travel between departments and floors; able to use stairs and elevators as needed.
• Lifting/carrying: Occasionally lift and carry items up to 25 lbs. Frequent handling of light items (up to 10 lbs).
• Pushing/pulling: Occasionally push/pull carts, file cabinets, or supply trolleys (force up to 25–30 lbs).
• Manual dexterity: Frequent fine motor skills and bilateral hand use for typing, data entry, filing, stapling, and handling paperwork; frequent keyboard/mouse use.
• Repetitive motion: Frequent repetitive hand, wrist, and finger movements for typing and office tasks.
• Vision: Visual acuity (near and distance) sufficient for reading computer screens, printed records, labels, and small-print forms; ability to distinguish colors for charting/labeling.
• Hearing/speech: Ability to hear and understand speech in person and on the telephone; clear verbal communication for patient/family/staff interactions.
• Environmental tolerance: Ability to work in a typical hospital office environment with variable noise, busy foot traffic, and occasional exposure to clinical areas; may be exposed to dust, cleaning chemicals, and latex (or latex alternatives).
• Cognitive/attention: Ability to concentrate, multitask, prioritize, follow procedures, and maintain accuracy under interruptions.
• Work schedule: Ability to work scheduled shifts, including occasional overtime, early/late hours, weekends, or on-call duties if required.

Note: Reasonable accommodations will be considered for qualified individuals with disabilities.