Coordinator, Denial Management Hospitals (On-Site, Hybrid, Remote)
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.
Requirements
- Associate’s degree preferred, or an equivalent combination of education and/or at least 3 years of related experience.
- All new hires will be required to complete the HFMA Certified Revenue Cycle Representative (CRCR) training course within the first nine (9) months of employment. Membership, training, and certification costs will be sponsored by the employer.
- 5 years of experience in professional/hospital billing, with in-depth knowledge of CPT, ICD, and HCPCS coding.
- Understanding of payer contracts, payment structures, and federal/state regulations.
- Proficiency with compliance laws and collection laws.
- Excellent oral and written communication skills.
- Proficiency in PC applications and Microsoft Office Suite, especially Excel.
- Strong analytical skills with attention to detail.
- Skilled in training and providing education to staff.
- Strong organizational skills.
- Demonstrates the True North values. The True North values are a set of value-based behaviors that are to be consistently demonstrated and role modeled by all employees that work at NorthBay Health. The True North values principles consist of Nurture/Care, Own It, Respect Relationships, Build Trust and Hardwire Excellence.
- Ability to prioritize tasks and communicate delays effectively.
- Communicate clearly across all organizational levels.
- Collaborate effectively with team members for professional communication and inclusion.
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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
