Denials and Authorization Coordinator at Scotland Memorial Hospital – Laurinburg, North Carolina

Position Summary the Denials/Authorization Coordinator is responsible for overseeing the denial process along with authorization to ensure timely resolution of claim denials and compliance with payer requirements. This role focuses on reducing revenue leakage, improving cash flow, and maintaining compliance with regulatory and contractual obligations.

Duties and Responsibilities

Denial Management: Develop and implement strategies to reduce claim denials and improve first-pass claim acceptance rates. Monitor denial trends and root causes; collaborate with clinical and administrative teams to address systemic issues. Oversee timely appeal of denied claims and ensure proper documentation for successful resolution.

Authorization Oversight: Ensure all required authorizations are obtained prior to service delivery. Maintain compliance with payer guidelines and regulatory requirements for prior authorizations. Collaborate with SPN offices to identify and resolve gaps in authorization workflows, improving efficiency, and reducing delays. Oversee all outpatient authorization processes within Scotland Healthcare System to ensure compliance with payer requirements. Train staff in authorization processes and updates from payers. Educate and support staff on authorization procedures, payer guidelines, and documentation requirements to maintain accuracy and compliance Team Leadership: Mentor and assist staff responsible for denials and authorizations along with assisting in drafting appeals. Set performance goals, conduct evaluations, and provide ongoing education. Reporting & Analytics: Prepare and analyze denial and authorization reports for leadership. Identify trends and recommend process improvements to reduce denials and delays. Compliance & Quality: Ensure adherence to HIPAA and other regulatory standards. Maintain accurate documentation and audit readiness. Position Qualifications

Education:

Bachelor’s degree in Healthcare Administration, Business, or related field (preferred).

Experience

Minimum 3–5 years of experience in revenue cycle management, denials, and authorizations. Strong knowledge of payer requirements, medical terminology, and coding. Excellent leadership, communication, and problem-solving skills. Proficiency in EHR and billing systems Experience working with clinical staff, case Management, finance teams to resolve issues Background in tracking denial trends, creating reports, and recommending process improvements.

Knowledge, Skills, Abilities

Strong organizational skills and ability to prioritize tasks Strong interpersonal skills and ability to work with a wide variety of individuals Knowledge of payer reimbursement process and insurance terminology Understanding of procedure codes (CPT, HCPCS, ICD 10 coding, etc.) Ability to identify and solve problems independently Understand Spreadsheets and how to read and analyze data Excellent computer skills and the ability to adapt to various programs/systems Excellent in verbal and communication skills