Denial Management Coordinator in ROCHESTER, New York at Rochester Regional Health

Position Summary:

The Denial Management Coordinator oversees the coordination and tracking of Rochester Regional Health responses to the Centers for Medicare and Medicaid Services (CMS) Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), Comprehensive Error Rate Testing Contractors (CERT) pre and post payment reviews as well as medical necessity and/or DRG denials for non-governmental commercial payers for both inpatient and outpatient encounters. Demonstrates knowledge of healthcare compliance, revenue cycle and audit recovery activities. The position requires strong communication skills, time management, and organizational skills as well as the ability to work collaboratively with clinicians, support, staff and senior leaders through the RRH system.

Key Responsibilities:
• Coordinate response to all denial inquiries to ensure all submissions are within mandated timeframes. Assist with written response and collection of all required information through the adjudication process to ensure it is complete, comprehensive and convincing.
• Prioritize review of claims by evaluating due dates and impact by revenue and volume on health system.
• Receive, log and track all denial activity and correspondence for government and commercial payers for both inpatient and outpatient.
• Maintain accurate database of all denial activity to closure to help manage and track denial hand-offs between departments
• Develops and maintains clear communication channels with internal insurance reviewers and recovery audit contractors
• Utilizes aggregate denial activity data to provide HIM Leadership with information that will support the health system in identifying areas in need policy, procedure or process improvement related to documentation, coding errors and/or utilization management issues.
• Works closely with Physician Advisor team to escalate issues and provide education to providers on emerging issues.
• Partners with HIM Leadership and key health system personnel to limit risk of past and future payment errors identified by federal and state contractors as well as private insurers.
• Identify common and overlapping issues. Alert health system leadership of targeted service lines.
• Develops and prepares various reports for RRH Senior Leadership, key medical staff and clinical department leadership.
• Works with the Denials Specialist and Physician Advisor leadership to develop and refine policies and procedures in order to ensure standard processes are in place across the system.
• Develops and documents procedures and training materials for data collection within the denial tracking software. Trains new staff on processes and software functionality.
• Coordinate ad hoc meetings, as needed, on an immediate basis; if/when denial activity requires swift review and determination of health system response.
• Provides RRH Leadership with updates on process changes or present and future denial regulations and/or modifications.
• Maintains access to the database tracking mechanism to include adding new users and deactivating uses as applicable.

Desired Attributes:
• Experience with claim denials, audit management and appeal processing, preferred.
• Current certification as an RHIA, RHIT, RN, CCS, or CCS-P, preferred
• Experience working with coding, revenue cycle, and utilization management, preferred
• Knowledge of medical necessity, coding and documentation guidelines for Medicare, Medicaid and other third party payers, preferred.
• Experience with Epic EHR, preferred
• Experience in preparing and presenting educational material to staff and providers, preferred

Minimum Qualifications:
AAS or two or more years of relevant work experience within the healthcare revenue cycle, e.g. Patient Access, HIM, PFS, or other role related to denial management.

Required Licensure/Certification Skills:
• RHIT or RHIA; CCS preferred
• Earned coding credential of Certified Coding Specialist (CCS) preferred.

Rochester Regional Health is an Equal Opportunity / Affirmative Action Employer. Minority/Female/Disability/Veteran

EDUCATION:

• AS: Health Information Management (Required)
• BS: Health Information Management

PHYSICAL REQUIREMENTS: S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

PAY RANGE: $19.75 - $24.50

The listed base pay range is a good faith representation of current potential base pay for successful applicants. It may be modified in the future. Pay is determined by factors including experience, clinical licensure date, relevant qualifications, specialty, internal equity, location, and contracts.