Job Description

Status: Full Time - 80 hours

Hours: 8A-430P

In an environment of continuous quality improvement, the Denials Management Coordinator is responsible for reviewing all denials to determine patterns in errors, payors, and internal processes to improve our denial rate. Exhibits the MHS Standards of Excellence and exercises strict confidentiality at all times.

Job Requirements:

• High School Diploma or GED required.
• Minimum of two years of previous experience in a healthcare-related position required
• Experience in coding, medical necessity, registration, insurances, and precertification processes and/or denials preferred
• Minimum of 2 years of experience or formal education in basic ICD10 coding, medical terminology, Anatomy/pathophysiology, and disease process preferred.
• Depending on healthcare-related experience, may require coding certification within 2 years of date of hire. Experience reviewing ambulatory claim denials preferred.
• Computer skills (word processing, spreadsheet, graphics, and database software applications)
• Strong quantitative, analytical and organization skills
• Strong negotiation skills
• Proficient in payment review systems, hospital information systems and coding methodologies
• Ability to understand medical records, hospital bills, and the charge master.
• Ability to understand all ancillary department functions for the facility.
• Ability to understand complex insurance terms and payment methodologies.
• Ability to effectively negotiate with insurance carriers and customers.
• Ability to utilize and understand computer technology.
• Ability to communicate orally and in written form.
• Team-orientated with strong interpersonal skills.

Job Functions:

• Analyzes all denials for patterns.
• Works with front line staff and educate on proper processes.
• Ability to verbalize to insurance carriers and write appeal details to support additional payment on denied claims.
• Accurately and consistently documents the results of all denial reviews in the hospital information system.
• Prepares reports as required by management regarding audit results, process improvement recommendations and systemic payment errors.
• Makes monthly observations and recommendations to prevent future denials.
• Assumes all other duties and responsibilities as necessary.

Compensation Details: Education, experience, and tenure may be considered along with internal equity when job offers are extended. Minimum hiring rate for this position is listed below.

Benefits

Memorial Health System is proud to offer an affordable, comprehensive benefit package to all full time and flex time employees.

• Medical Insurance - PPO & HDHP
• Dental and Vison Insurance
• Health Saving Account
• Flexible Spending Account
• Dependent Care
• Pension Plan - Defined Contribution
• 403b Retirement Plan
• Voluntary Life Insurance
• Short-Term & Long-Term Disability
• Vacation Time
• Sick Time
• Holiday Pay & Premium
• Shift Differential
• Tuition Reimbursement
• Tuition Repayment
• Performance & Market Increases
• Relocation Package, if applicable

This position is patient facing and/or requires close interaction with other employees, or other factors that would compel mandatory vaccinations unless otherwise approved for a medical or religious exemption.

Memorial Health System is an equal opportunity provider and employer.

If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at , or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W., Stop 9410, Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at .

Other details

• Job Family Non-Clinical
• Job Function Frontline Employee
• Pay Type Hourly
• Min Hiring Rate $16.13

• Reno Business Park, 27823 State Route 7, Reno, Ohio, United States of America

Memorial Health System