Job Summary
The Denials & Appeals Coordinator is responsible for managing, tracking, and resolving denials and appeals to ensure timely reimbursement. This role requires in-depth knowledge of payer guidelines, systems, and requirements to navigate complex denial cases effectively, assist in issue resolution, and help identify trends that can improve claim outcomes. Essential Functions
Monitors assigned queues and duties across various systems (such as, Artiva, HMS, Hyland, BARRT) to ensure all follow-up dates are current.
Analyzes denials to determine appropriate actions, completes appeals, or routes cases for clinical appeals as needed.
Files and monitors appeals to resolve payer denials, documenting all activity accurately and maintaining logs, account notes, and system records.
Maintains an up-to-date understanding of payer guidelines and requirements related to denials and appeals.
Processes BARRT requests, reviews RAC/Government Audit accounts, and completes necessary rebills and adjustments.
Identifies trends in denials to suggest improvements and reduce future claim issues, providing data for denial and appeal trends as needed.
Performs other duties as assigned.
Maintains regular and reliable attendance.
Complies with all policies and standards.
Qualifications
H.S. Diploma or GED required
Associate Degree or higher in Health Information Management preferred
1-3 years of experience in medical billing, revenue cycle, or claims denials and appeals processing required
Prior experience with revenue cycle processes in a hospital or physician office setting required
Knowledge, Skills and Abilities
Strong knowledge of payer guidelines, medical billing practices, and appeal processes.
Proficiency in relevant software and claim management systems, such as Artiva, HMS, Hyland, and BARRT.
Excellent analytical skills for reviewing denial trends and suggesting improvements.
Strong verbal and written communication skills to interact with payers and internal departments.
Ability to prioritize tasks effectively and manage time in a fast-paced environment.
Licenses and Certifications
