Denials and Appeals Coordinator - Remote Opportunity

About the Role

The Denials and Appeals Coordinator is tasked with managing, monitoring, and resolving claims denials and appeals efficiently to guarantee timely reimbursement. This position entails utilizing extensive knowledge of payer protocols, systems, and regulations to tackle complex denial scenarios, assist in resolving issues, and identify recurring trends to improve claim outcomes.

Key Responsibilities

• Oversee assigned queues and responsibilities within various platforms such as Artiva, HMS, Hyland, and BARRT to maintain up-to-date follow-ups.
• Analyze denial cases to determine appropriate corrective actions, complete necessary appeals, or escalate to clinical appeals when required.
• Submit and track appeal filings to address payer denials, meticulously documenting all transactions, maintaining logs, notes, and system records.
• Stay current on payer guidelines and requirements related to denials and appeals.
• Manage BARRT requests, examine RAC and Government Audit accounts, and execute rebills and adjustments as needed.
• Detect denial trends to recommend improvements that reduce future claim denials and provide supporting data for trend analysis.
• Perform additional duties as assigned, ensure regular attendance, and adhere to organizational policies and standards.

Qualifications and Experience

• High school diploma or GED is mandatory, with preference given to candidates holding an associate degree or higher in Health Information Management.
• Possess 1 to 3 years of experience in medical billing, revenue cycle, or managing claims denials and appeals.
• Experience working within revenue cycle operations in either hospital or physician office environments is required.

Skills and Competencies

• Solid understanding of payer policies, medical billing procedures, and appeals workflow.
• Proficiency in specialized software and claim management systems including Artiva, HMS, Hyland, and BARRT.
• Strong analytical capabilities to interpret denial patterns and recommend process enhancements.
• Excellent communication skills, both spoken and written, to liaise effectively with payers and internal teams.
• Ability to manage priorities and maintain productivity in a fast-paced setting.

Preferred Certification

Certified Revenue Cycle Specialist (CRCS) credential from AAHAM is preferred.

About the Organization

The Payment Compliance and Contract Management team is instrumental in guaranteeing that payments align with contractual obligations and regulatory mandates. The group manages contract lifecycles to examine reimbursement variances, enhance revenue cycle processes, and uphold contract compliance, thereby supporting financial accuracy and operational efficiency.

Community Health Systems operates as one of the largest healthcare providers in the country, managing healthcare delivery systems across 40 markets in 15 states with acute-care hospitals, physician offices, urgent care, emergency departments, and various other healthcare services.

Employee Benefits

• Comprehensive health benefits including medical, dental, and vision coverage for employees and their families.
• 401(k) retirement plan with employer matching to aid future financial security.
• Student loan repayment assistance up to $10,000 to support educational debt relief.
• Educational tuition assistance programs to promote ongoing learning.
• Competitive salary and full benefits package rewarding expertise and commitment.