Denials Management Coordinator
Location: St. Dominic Hospital
Department: ACCOUNTING - 9020
Employment Type: Full Time 80
Other Shift Details:
Job Code: 7715
Provides a professional link between the Medical Staff , Clinical Documentation Specialists and Coding Specialists and provides education in maintaining and improving coding accuracy and physician documentation.
Bachelor’s Degree in Health Information management preferred. Registration as Health Information Administrator (RHIA) or Health Information Technician (RHIT) or certification by the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC) as a Certified Coding specialist (CCS), Certified Professional Coder (CPC) or Professional Coder-Hospital (CPC-H) preferred. Must have strong computer, verbal and written communication skills. Proficient in public speaking, presentations, and educational activities. Advanced knowledge of medical terminology, CPT and ICD-9-CM and HCPCS coding, Medicare, Medicaid and commercial insurance procedures.
Minimum Work Experience
Two or more years coding experience in a health related setting.
Provides a positive and professional representation of the organization. Promotes culture of safety for patients and employees through proper identification, reporting, documentation, and prevention. Maintains hospital standards for a clean and quiet patient environment to maintain a positive patient care experience. Maintains competency and knowledge of current standards of practice, trends, and developments in related scope of job role or practice. Adheres to infection-control policies and protocols, medication administration and storage procedures, and controlled substance regulations. Participates in ongoing quality improvement activities. Maintains compliance with organization’s policies, as well as established practices, protocols, and procedures of the position, department, and applicable professional standards. Complies with organizational and regulatory policies for handling confidential patient information. Demonstrates excellent customer service through his/her attitude and actions, consistent with the standards contained in the Vision, Mission, and Values of the organization. Adheres to professional standards, hospital policies and procedures, federal, state, and local requirements, and TJC standards and/or standards from other accrediting bodies.
1. Researches and analyzes denial data and coordinates denial recovery responsibilities.2. Identifies, analyzes, and researches frequent root causes of denials and develops corrective action plans for resolution of denials3. Develop reporting tools that effectively measure and monitor processes throughout the denials management process in order to support process improvement4. Provides training to Clinic Staff and Providers.5. Prioritizes activities to process overturns in a timely manner to alleviate untimely filings6. Uses reports that categorize denials to assign tasks or work to overturn denials7. Identifies and pursues opportunities for improvements in denial performance8. Assists with inpatient/outpatient coding audits 9. Assists with developing inpatient and outpatient Query templates for clarification