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Overview

The Denial Escalation Coordinator’s primary focus will be to escalate accounts outside the payer’s formal appeal process to secure payment for services provided. This position will evaluate the adequacy and effectiveness of internal and operational controls designed to ensure that processes and practices lead to appropriate adjudication of claims for denial prevention. This role requires thorough understanding of regulatory requirements, managed care contract terms, facility-specific internal guidelines, registration, revenue integrity, billing, coding, cash applications, payment variances and adjustment processing including federal and state regulations and guidelines. The Denial Escalation Coordinator will be responsible for analyzing and interpreting trends associated with inventory and weekly departmental reporting.

The position will require thorough analysis and interpretation of payer contracts as well as state and federal regulatory guidelines in order to maximize revenue reimbursement. Efforts previously described will result in increased net revenues by reducing bad debt from potential write-offs due to lack of collections and overturns on payer denials through the appeals process. The role will collaborate with upper management to analyze and report trends associated with the write off and appeals processes as well as provide education back to team members for successful front-end processes and appeal writing skills to prevent and overturn denials. This position will work with all base class of accounts including IP, OP and Oncology accounts as applicable to the role.

Requirements, Preferences and Experience

Experience with patient collections, registration and/or scheduling.

Basic understanding of Revenue Cycle functions, flow, and operations strongly preferred.

Experience level will also be a factor in lieu of educational requirements.

Education/Experience/Certification/Licensure/Technical/Other

II.Experience: 2-4 years’ experience in dynamic healthcare (clinic, physician, or acute hospital setting) or payer environment performing activities such as patient collections, payment applications, denials, registration and/or scheduling required. Appeal writing and payer experience preferred.

III.Certification/Licensure: Certified Healthcare Access Associate (CHAA) a plus.

IV.Software/Hardware: Comfort with data entry using Revenue Cycle software, patient management systems, payer systems and Windows-based applications preferred; competent utilizing Microsoft Office (Excel, Word, Powerpoint) a plus.

REQNUMBER: 32646