RCM Denial coordinator
Job Description
Job Description
Position Summary
Analyze and resolve denied claims to maximize revenue recovery for healthcare providers.
Job Duties
- Identify reasons for claim denials, analyze denial patterns, and track denial trends.
- Initiate and coordinate the appeals process for denied claims, ensuring proper documentation is provided and timely follow-up is conducted.
- Collaborate with relevant departments (e.g., billing, coding, insurance, clinical) to identify the root causes of denials and implement solutions to prevent future denials.
- Be available to meet face to face with departments at hospital locations.
- Properly track and document all denial and appeal activities, including logs, account notes, and system records.
- Establish and maintain relationships with payer representatives to facilitate claim resolutions.
- Act as a resource for staff questions related to claim denials and timely filing, and potentially train and mentor team members.
- Analyze denial trends and root causes, and prepare reports for management.
- Performs other duties as assigned
Qualifications and Skills
- Strong understanding of healthcare billing processes and insurance regulations.
- Proficient knowledge of medical billing and coding (e.g., ICD-10, CPT).
- Excellent analytical and problem-solving skills.
- Strong communication and interpersonal skills.
- Proficiency in relevant software applications, such as Microsoft Office Suite and revenue cycle management software.
Education, Experience and Certification/Licensure Requirements
- Previous experience in healthcare billing, collections or revenue cycle management with specific experience in denial management being highly preferred.
- High school diploma or GED required. Bachelors degree or equivalent experience in healthcare administration, business or finance preferred.
- Thorough understanding of CMS regulations as it relates to OP observation billing and use of code 44.
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