Denials Coordinator

Major Responsibilities:

• Identifies, evaluates, analyzes, and designs integrated solutions specific to the denial management function.
• Coordinates the denial data collection activities used for reporting and accountability tracking. Communicates denial management program results to the Interventional Cardiology (IC) and Interventional Radiology (IR) leadership team. Maintains and tracks denied/recaptured totals.
• Works and processes all necessary work queues related to the IC and IR areas in conjunction with finance and the IC and IR leadership teams.
• Identifies potential compliance concerns and opportunities for revenue generation, and provides appropriate investigation, follow-up, and resolution. Researches and analyzes applicable regulatory, coding and billing rules and educates the department on regulations, processes, and medical necessity requirements.
• Works with business manager, finance, coding, and auditing staff to review the new codes and regulatory changes to establish the charge master. Maintains up to date information regarding appeals, denials and coding and communicates/distributes the changes accordingly.
• Identifies and problem solves issues. Collaborates with department staff, physicians as well as the denials management team to follow-up on these issues on a regular basis. Communicates with and acts as a resource for physicians, leadership and staff regarding coding and denial issues.
• Works with the medical staff, IC, and IR departments in expediting care delivery and appropriate documentation to avoid delays in timely service provision. Validates the care that is provided.
• Provides education, feedback, and clinical expertise to the department on complex auditing issues/processes to ensure consistency and accuracy in clinical audits and the charging and billing process.
• Develops and maintains the charge sheet for the IC and IR areas and review of charges along with the necessary staff education for proper charging.

Licensure, Registration, and/or Certification Required:

• Registered Technologist (RT) registration issued by the American Registry of Radiologic Technologists (ARRT), or
• Cardiovascular Invasive Specialist registration (RCIS) issued by the Cardiovascular Credentialing International (CCI)., or
• Registered Nurse license issued by the state in which the team member practices,

Education Required:

• Associate's Degree in Allied Health, or
• Associate's Degree in Nursing.

Experience Required:

• Typically requires 3 years of experience in an Interventional Cardiology and/or Interventional Radiology department or 3 years of experience reviewing and posting charges in Cupid and/or Radiant in Epic.

Knowledge, Skills & Abilities Required:

• In-depth knowledge of and experience with medical center reimbursement models.
• Excellent interpersonal skills for interaction and collaboration with physicians, payors and peers.
• Demonstrated proficiency in the Microsoft Office Suite (Word, Excel, PowerPoint) or similar products.

Physical Requirements and Working Conditions:

• Must be able to sit, stand, and walk for prolonged periods.
• Exposed to normal office environment.
• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.