Denials Coordinator

Job Summary

Ensures that timely accurate and complete data is submitted to appropriate insurance companies to guarantee prompt payments to Corewell Health. Communicates and collaborates with the multidisciplinary team through verbal and written communication. Participates with Care Team for the integration of the patient to the home or transitional environment by developing planning implementing and evaluating in accordance with current existing federal state and local standards. Adheres to confidentiality policies specific to communications patient confidentiality record keeping and coordination services.

Essential Functions

• Understanding of the revenue cycle and the responsibility and goals of each area and how they impact the revenue cycle.

• Review all accounts that have a payer denial based on the Denial Management Policy and Procedure and take appropriate action based on the type of denial.

• Documents all necessary elements; reason for denial/audit denial status action taken in the electronic medical record per denial management policy.

• Understanding of current payer contracts.

• Apply corrections to patient demographics charges adjustments and payments or when needed forwards to the appropriate department for correction.

• Identify and provide communication and education on trends identified.

• Appeal denials based on the appeal criteria found within the Denial Management policy and within appropriate denial due date timeframes.

• Work with facility departs when necessary for resolution or appeal of denials related to that department (i.e Lab Patient Access Case Management).

• Prepare and distribute a monthly denial log by facility to include account number payor type reason for denial when requested.

• Identifies and communicates monthly denial trends and provides education as necessary to avoid recurring denials for the same denial reason code.

• Send identified medical records as part of the denial/audit process via variety of methods- expedited mail electronic portal payor portal or expedited ground currier service. Will document appeal/additional documentation was sent in the electronic medical record once completed.

• Follows payor or contractor denial/audit rules and timelines as outlined. Performs appropriate follow up with payors on status of appeals/audits.

• Follows appropriate next steps when denial has been upheld and completes correct adjustment process after the first level of denial is upheld.

• Maintains a professional image and provides excellent customer service.

Qualifications

Required

• Bachelors Degree or equivalent education and experience

• 3 years of relevant experience or more working in patient financial services revenue cycle or similar field

About Corewell Health

As a team member at Corewell Health you will play an essential role in delivering personalized health care to our patients members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators leaders and innovators that continue to build on one shared mission statement - to improve health instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial health and work/life balance goals. Learn more here.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!
• Optional identity theft protection home and auto insurance
• Traditional and Roth retirement options with service contribution and match savings
• Eligibility for benefits is determined by employment type and status

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Corewell Health is committed to providing a safe environment for our team members patients visitors and community. We require a drug-free workplace and require team members to comply with the MMR Varicella Tdap and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process to perform the essential functions of a job or to enjoy equal benefits and privileges of employment due to a disability pregnancy or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race color national origin sex disability age religion genetic information marital status height weight gender pregnancy sexual orientation gender identity or expression veteran status or any other legally protected category.

An interconnected collaborative culture where all are encouraged to bring their whole selves to work is vital to the health of our organization. As a health system we advocate for equity as we care for our patients our communities and each other. From workshops that develop cultural intelligence to our inclusion resource groups for people to find community and empowerment at work we are dedicated to ongoing resources that advance our values of diversity equity and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.