Denials & Appeals Coordinator - Revenue Integrity

Kingman Regional Medical Center•Kingman, AZ

About The Position

Unlock your potential for professional development! We are hiring a Denials & Appeals Coordinator to join our Revenue Integrity team! Located in northwest Arizona, Kingman has a mild climate with stunning Arizona sunsets! In the shadows of beautiful mountain ranges and nearby lakes, Kingman is an outdoor enthusiasts' paradise with abundant sunshine and is a great community to live, work and play! Position Purpose All KHI employees are expected to perform their respective tasks and duties in such a way that supports KHI’s vision of providing the region’s best clinical care and patient service through an environment that fosters respect for others and pride in performance. In an environment of continuous quality improvement, this position requires knowledge of insurance guidelines and appeals submissions. The Denial Coordinator is vital to ensure that hospital / physician denials are analyzed, tracked, trended and appropriate education is provided, in order to reduce the denials and increase hospital reimbursement.

Requirements

Required Education: High School Diploma or equivalent
Required Experience: Two or more years of experience in a hospital business / physician practice environment performing billing/collections.
Required Knowledge, Skills, & Abilities: Demonstrate knowledge of ICD-10 and CPT coding, reimbursement analysis. Demonstrate clear written and verbal communication skills. Demonstrate knowledge of Medical Terminology. Strong organizational skills and the ability to multi-task. Claims processing background. Intermediate understanding of Explanation of Benefits (EOB’s), Managed care contracts, Federal and State requirements for payment. Intermediate knowledge of hospital form requirements (UB04) and/or HCFA 1500. Understanding of ICD-10 HCPC/CPT coding and medical terminology and charges associated with services.

Responsibilities

Maintain strong working relationships with the payer(s) to ensure claims are being processed appropriately and to assist with identifying any errors within the payer(s) system.
Ability to resolve denials and submit appeals according to the payer specific guidelines and to protect the net revenue of KRMC.
Ability to review and analyze complex claims denials and appeal with supporting documentation in writing or/ verbal that result in positive outcomes.
Shows solid problem solving and analysis skills that demonstrate resourcefulness and attention to detail. Tracks and follows appeal to completion.
Provides excellent customer service and adheres to the Behavioral Expectations Agreement. Exhibits courtesy, cooperation and respect toward patients, visitors, physicians, supervisor, and coworkers in regard to all personal and telephonic interactions.
Researches and documents denials at all levels of provider reconsideration/appeals in a thorough, professional and expedient manner. Denial to be investigated and corrected within 5 business days by implementation of strong analytical skills.
Reviews and determines the root cause of the denial and focus on getting the cause corrected long term. Work with insurance companies, documents issues and reports finding to your Manager so that both back end and front end issues can be resolved for avoidance of future denials. Informs Manager of patterns that are of concern that effect reimbursement and recommend in-service training.
Tracks and captures the Medical Necessity concerns as they relate to services being rendered and documented by the health care team. Is responsibility for review of documentation for the evaluation of 5449 (Init:08/17ms; Rev: 2/18sn Rev: 4/18sn) (Please refer to electronic document management system for the most current revision) medical necessity and appropriate clinical setting in the successful filing of appeals. Work with Case management as need to clarify appropriate clinical setting denials.
Represents the hospital in a professional fashion when necessary in speaking with the insurance companies, prepares for the phone call and organizes the files in a manner that would enable the Manager / Director to perform this duty as needed and necessary.
Provides charge error trends to Manager as needed in order to facilitate improvement in chart documentation and accurate keying of charges. Performs and communicates in a highly professional manner at all times.
Consistently demonstrates the ability to assess a situation from a variety of perspectives; considers alternatives and chooses the most appropriate course of action; works well with co-workers and other department personnel in the resolution of claim denial issues. Ensures positive outcome and goals, and safeguards the public image of the hospital.

Benefits

Exceptional Colleagues
Health and Well-Being
Medical, Dental, Vision, Employer Paid HSA for HDHP participants, Robust Wellness and Employee Assistance Program, Employer Paid Group Life, Short & Long-Term Disability
Generous Paid Leave Accruals
403b Pension Plan with Employer Contributions
Employee Recognition Programs, Employee Discounts, and Employee Referral Bonus Program
Employee Identity Theft Protection
On-site daycare exclusive to our employees’ children of all ages
Career Growth and Development
Tuition Reimbursement/Scholarships for full-time employees
As a not-for-profit organization, our employees who have qualified student loans may be eligible for the Public Service Loan Forgiveness program
So much more!