Denials Management Coordinator

At Central Maine Healthcare our team members are committed to providing exceptional care and experiences for our community and for each other every day.

Position Summary: The Denials Management Coordinator is responsible for applying fundamental knowledge of billing, coding and payer requirements as it relates to researching, analyzing, and resolving denials, contractual underpayments and credits. This job requires regular outreach to payers and internal stakeholders. Duties include, but are not limited to:1. triaging incoming variance inventory2. validating appeal criteria is met in compliance with departmental policies and procedures3. composing technical denial language for reconsideration, including both written and telephonic4. ensuring high level of competence in process and payer knowledge to overcome objections that prevent payment of the claim5. gaining commitment for payment through concise and effective appeal composition6. identifying problem accounts/processes/trends and escalate as appropriate7. utilizing effective documentation standards that support a strong historical record of actions taken on the account8. resolving the account (posting correct contractual adjustments, posting other non-cash related Explanation of Benefits (EOB) information, updating the patient accounts as appropriate9. submitting uncollectible claims for adjustment timely and correctly10. resolving claims impacted by payer recoupments, refunds, and posting errors11. meeting and maintaining established departmental performance metrics for production and quality12. maintaining working knowledge of workflow, systems, and tools used in the department13. practicing and adhering to the Code of Conduct philosophy and Mission and Value Statement14. maintaining collaborative approach to problem solving working with other revenue cycle teams and revenue generating areas15. other duties as assigned 16. resolving accounts to 0 insurance balance Customer Service:1. Displays positive attitude. Treats others with honesty and respect. Speaks positively in all customer interactions internal and external. Education and Experience:1. 2 Year Degree or 6 years healthcare experience2. Six or more years of experience in health care billing functions 3. Ability to perform assigned tasks efficiently and in timely manner. 4. Ability to work collaboratively and effectively with people.5. Exceptional communication and interpersonal skills.6. Basic skills - demonstrates ability to organize, perform and track multiple tasks accurately in short timeframes; able to work quickly and accurately in a fast-paced environment while managing multiple demands; able to work both independently and collaboratively as a team player; demonstrates adaptability, analytical and problem solving skills, and attention to detail Knowledge, Skills, and Abilities:1. Completes appropriate actions needed for an effective appeal including conducting authorization research, rebilling, and balance write off or transfer to next responsible party. 2. Utilizes systems, various documents and reports to identify and correct errors accurately and within established deadlines.3. Escalates issues as appropriate. 4. Corresponds with third party payers, hospital departments, and patients to obtain information required for denial resolution following payer timelines. 5. Releases information following Federal, State and Hospital guidelines. 6. Uses assigned work queues and prioritization standards and guidelines to perform denial resolution follow up. 7. Uses reference material to troubleshoot payer issues and increase understanding of denial resolution techniques. 8. Reference payer websites as needed. 9. Analyzes and researches the denial reasons for each assigned denial code. Determines and executes the best approach for denial resolution utilizing all available resources. 10. Follows payers established procedures and timelines to submit appeals utilizing payers preferred method, i.e., electronically or via paper.11. Documents all actions taken during the denial resolution process clearly including actions taken, next steps, payer processing timelines, etc. 12. Adjusts account balances using correct transaction code adhering to established departmental policies.13. Follows established protocols to ensure all documents are retained appropriately Meets established quality and productivity standards. 14. Facilitates and promotes the sharing of knowledge and content throughout departments. 15. Follows all established Hospital Billing Revenue Cycle Management departmental and compliance policies and procedures.16. Participates in cross training of billing resources. 17. Demonstrates excellent attendance and actively participates in a variety of meetings and training sessions as required. 18. Maintains and fosters an organized, clean, and safe work environment. 19. Contributes to the development and application of process improvements. 20. Practices cost containment and fiscal responsibility through the efficient use of supplies, equipment, time, etc. 21. Complies with established departmental policies, procedures and objectives. 22. Attends variety of meetings, conferences, seminars as required or directed. 23. Demonstrates use of Quality Improvement in daily operations. 24. Complies with all health and safety regulations and requirements. 25. Respects diverse views and approaches, and contributes in maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors. 26. Performs other similar and related duties as required or directed. Physical Environment:1. Most duties do not generally present an occupational risk, however, failure to follow standard procedures and safety rules may expose the employee to potential injury e.g. falls on slippery floors, etc. Physical Requirements:1. Must be in good physical condition to meet the demands of an active position including moderate walking, sitting, standing, and twisting and moderate hand/wrist motion.

If you are passionate about making a difference and are looking for your next great career opportunity, we look forward to reviewing your application!