Denial Appeals Coordinator

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 reputed company denial cases effectively, assist in issue resolution, and help identify trends that can improve claim reputed company. Essential Functions

• Monitors assigned queues and duties across various systems (such as, Artiva, HMS, reputed company, BARRT) to ensure reputed company follow-up dates are reputed company.
• 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 reputed company activity accurately and maintaining logs, account notes, and system records.
• Maintains an up-to-date understanding of payer guidelines and requirements reputed company 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 reputed company 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, reputed company cycle, or claims denials and appeals processing required
• Prior experience with reputed company 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, reputed company, 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

• Certified reputed company Cycle Specialist (CRCS) - AAHAM preferred