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Archbold · 3 months ago

DENIALS MANAGEMENT COORDINATOR

Thomasville, GA

Full-time

Onsite

Mid Level

3+ years exp

Archbold is seeking a Denials Management Coordinator to develop and manage a centralized program aimed at enhancing efficiency in coding and audit reviews for patient accounts. The role involves analyzing data related to payer audits and denials, and working closely with various stakeholders to improve healthcare delivery and reduce financial risks associated with claims denials.

Health CareHospitalNon Profit

Growth Opportunities

Responsibilities

Reviews and analyzes current audit information to identify opportunities for improvement internally and payers

Maintains reporting specific to audit statuses, identifying internal and payer patterns to better manage payer issues proactively

Update and maintain audit tracking spreadsheets outside of RAC software

Develop and maintain procedural documentation

Identify and resolve system and payer issues that result in payment delays, incorrect payments

Service as a PFS, PAS, HIM, Compliance, Contract Management, Clinical Liaison to third party payers, and other parties in a problem-solving or information capacity

Monitor deadlines and ensure all parties meet timely filing for appeal deadlines

Assist with auditing involving any third-party commercial payer

Participate in payer meetings to discuss appeal progress and identify trends with payer processing appeals to resolve cases

Establish and enforce internal audit policies including pre-payments audits

Collect and analyze data from audits and concurrent reviews to identify recurring problems

Acts as a coordinator and mentor to RID Denial Staff

Qualification

Denials managementCoding knowledgeHealthcare experienceRegulatory researchData analysisMicrosoft applicationsCommunication skillsProblem-solving abilitiesTeam collaboration

Required

Minimum of an Associate's Degree in Business, Paralegal Studies, Coding, Healthcare, or related field

Two (2) years of relevant experience in Compliance, Coding, HIM, Insurance denials, or Legal experience may be considered in lieu of an Associate's degree

Minimum three (3) years' experience within the healthcare field performing any variety of organizational, administrative, or process improvement functions

Excellent oral and written communication skills

Establish and maintain professional and cooperative relationships

Efficient and effective analytical skills

Ability to research regulatory requirements

Effective human relations abilities

Proficiency with Microsoft applications and other applicable software and database management applications

Effective problem-solving abilities

Strong ability to effectively collaborate alliances and promote teamwork