Coordinator, Denial Management Hospitals (Full Time, Day)

NorthBay Health • Fairfield, CA

6d

About The Position

At NorthBay Health, the Coordinator, Denial Management is responsible for the
monitoring, analytics, reporting, and coordination of pro-fee health care claims
denials and underpayments. The incumbent will work with the PFS division,
practice operations, providers, and other facility staff to create reports,
monitor trends, and provide feedback and/or training, as well as corrective
oversight for billing, coding, and contracts as determined based on claim
denials, edits, and underpayments.  The purpose of obtaining appropriate
reimbursement under contract or related government fee schedule.

At NorthBay Health, we are guided by our values: Nurturing Care; Own It;
Respect; Build Trust; and Hardwire Excellence. These principles lead us to our
TRUE NORTH and inspire us to provide exceptional care. 

These values serve as the foundation of everything we do, guiding us to deliver
individualized care with integrity and accountability. We are committed to
fostering a culture of collaboration, where every team member is valued and
empowered to contribute their best to the health and well-being of those we
serve. 

This is an exciting time to join NorthBay Health.

As an independent, nonprofit health system north of the San Francisco Bay Area,
in the Napa/Solano Region, we are expanding our footprint across Solano, Yolo,
and Napa counties to meet the evolving needs of our communities. With two
acute-care hospitals—including a Level II Trauma Center and a modern maternity
unit with a Level III Neonatal Intensive Care Unit (NICU)—along with a
comprehensive cancer center, multiple urgent care facilities, and a growing
network of primary and specialty clinics, we are investing in the future of care
across the region.

NorthBay Health we are home to advanced clinical programs and nationally
recognized cardiovascular, neuroscience, and orthopedic services, as well as
comprehensive surgical and outpatient specialties. Our commitment to excellence
is reflected in our Magnet with Distinction designation for nursing (one of only
12 organizations nationwide) and recognition from U.S. News & World Report as
“High Performing” in multiple clinical areas, including maternity care, heart
failure, and stroke. NorthBay Medical Center has earned the High Performing
designation in maternity care for four consecutive years.

As the only locally governed health system in the region, we remain deeply
rooted in our communities while growing into a trusted regional healthcare
leader. If you are seeking meaningful work, collaborative teams, and the
opportunity to help shape the future of healthcare in Northern California, you
will find it at NorthBay Health.

Join us with our commitment to excellence, to achieve our vision to be the
trusted healthcare partner of choice for the communities we serve.

To learn more about NorthBay Health's benefits, diversity statement and
community please visit https://www.northbay.org/careers/
[https://www.northbay.org/careers/index.cfm]

Responsibilities

• Create, review, and analyze payer underpayment and variance reports; distribute findings weekly and recommend corrective actions.
• Utilize EHR, billing systems, payer portals, and Microsoft Office tools effectively.
• Research and evaluate denial and underpayment trends; propose process improvements.
• Plan, organize, and prioritize workload to handle high volumes of data with accuracy and efficiency.
• Participate in meetings, trainings, and team development activities.
• Maintain current knowledge of eligibility requirements, payer guidelines, government regulations, and industry standards.
• Demonstrate comprehensive understanding of billing procedures, HIPAA 837P/835 files, CMS 1500, UB-04, CARC/RARC codes, and common claim edits.
• Provide training to PFS team based on data analysis.
• Collaborate with other departments to resolve denials and enhance processes.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed