Denials Coordinator - Cabell Huntington Hospital/St. Mary
Huntington, WV
About the Job
Summary: This position will own the HIM denials and appeals process end to end for all MHN and coordinate with other departments as needed. This will include logging, tracking, forwarding to appropriate departments/staff, coordinating responses, following up internally to ensure timeliness due to small window for responses, mailing/faxing/uploading denial letters and supporting documentation to payors or third parties, as well as tracking financial outcomes of denials for the organization. System Specific Duties and Responsibilities: * Reviews all denial accounts for categorization, level of appeal, special requirements for initiating appeals. * Maintains a clinical appeal process for all inpatient denials assuring that proper documentation is provided to support appeals of unauthorized inpatient days or days denied for lack of documentation. * Utilizes denial reports to assess root causes and identify trends. Share findings with stakeholders. * Leads HIM denial and appeal process, monitoring identified issues and progress, tracking and trending. * Coordinates timely processing of all appeals at all levels, i.e., initial appeals, second level response, progress reports. * Demonstrates, promotes, and monitors high standards of quality and productivity; focuses on quality results first. * Demonstrates understanding and sensitivity to compliance issues related to the corporate compliance plan. * Ability to analyze and interpret complex data. * Contributes to the overall HIM team goals. * Participation in educational meetings as directed. * Participation in committees as needed. * Maintain CEUs as necessary for credential maintenance (if applicable). * Maintains up to date knowledge base of reimbursement systems and regulations. * Maintains effective two-way channels of communication with HIM manager, Coding manager, CDI manager, HIM director and other departments. * Maintain patient confidentiality at all times. * Participates on teams, workgroups, and committees as needed. * Tracks HIM denials and appeals for MHN HIM end to end. * Ensures HIM denials and appeals are forwarded to the appropriate area for response (Coding, CDI, etc.). * Work closely with HIM, Coding, CDI, and other departments, coordinating the HIM denial and appeal process for timely responses. * Follows up on financial outcomes of HIM denials and appeals. * Will need to be articulate with excellent communication skills. * Comfortable working on PC, with knowledge of MSOffice and all applicable applications (Word, Excel, etc.) Education: Required: High School Diploma Preferred: RHIT or Coding Certificate Experience: Minimum of 5 years experience working in an HIM department.Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
Source : Cabell Huntington Hospital/St. Mary