Denial Management Coordinator (Full Time, Remote - Wisconsin Resident)

POSITION SPECIFICS
Title:  Denial Management Coordinator
FTE:  1.0 FTE (40 hours per week)
Schedule:  Monday through Friday, 8:00am – 5:00pm
Holiday Rotation:  None
Weekend Rotation: None
On Call Requirements: None
  
POSITION SUMMARY
The Denial Management Coordinator is responsible for reviewing all payor denials and post-payment audits received by Sauk Prairie Healthcare and will act as the main liaison for all denial processing and reporting.  This position will work closely with the Utilization Review, Coding, Clinical Departments and Revenue Cycle teams on clinical and medical necessity denials.

The Denial Management Coordinator oversees the root cause analysis, tracking and monitoring of all denials.  The work done facilitates the quality of healthcare delivery in areas of inpatient coding, DRG, outpatient, professional coding, and medical necessity.  The individual in this position will combine clinical, business, and regulatory knowledge to reduce significant financial risk and exposure caused by denials and audits of claims for services provided. 
 
POSITION TECHNICAL RESPONSIBILITIES

1. Complete review of all denials and any post payment audits, including government payor audits.
2. Execute the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party payors. Craft appeal letters and/or refer cases to vendor for review and appeal assistance. Ensure all appropriate clinical documentation is sent to support the appeal and that all efforts are documented in the electronic health record. Escalate issues as appropriate to ensure appeals deadlines are not missed.
3. Maintain third-party relationships, including responding to inquiries, complaints, and any other correspondence.
4. Responsible for tracking and reporting on financial performance relative to denial reductions and/or avoidance.
5. Lead organizational denial taskforce team, to foster awareness of denials and identification of root cause analysis.  Inform and educate the organization of changes to payor’s medical policies, which may impact workflows. Work closely with all clinical departments to mitigate denials.
6. Provide and/or coordinate education and/or workflow improvements surrounding denial prevention.
7. Pinpoint improvement opportunities and contributes to testing of system modifications; work closely with IT staff and department managers to ensure proper implementation.
8. Work closely with Denial Management Nurse, Utilization Review, Clinical Document Integrity Specialist, and Medical Coders on medical necessity and other clinical denials.
9. Monitor deadlines and ensure all parties are meeting timely filing for appeal deadlines.
10. Monitor and documents payor denial trends.  Work with third-party payors as need to identify and resolve payor specific trends.
11. Conduct relevant research to assist with completing the appeals process and to stay informed on best practices.
12. Ensure compliance with state and federal regulations governing patient services and reimbursement.
13. Scan and maintain all documentation as needed.
14. Other duties as assigned.

• Required:  Associates degree in Business or related field
• Preferred:  Bachelor’s Degree

• Required:  1 -3 years of previous healthcare financial experience, including medical terminology, insurance follow-up, or coding.
• Preferred:  4 or more years of previous healthcare financial experience, including medical terminology, insurance follow-up, or coding specific to denial management.

• Required:  None
• Preferred:  None

• Required:  None
• Preferred:  Coding Certification 

1. Competitive health and dental insurance options
2. Flexible paid time off to balance work and life
3. Retirement plan with immediate vesting and employer match
4. Free membership to our state-of-the-art fitness facility
5. Generous tuition reimbursement
6. Employer provided life and disability insurance
7. Free parking at facility