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Role Description

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 complex denial cases effectively, assist in issue resolution, and help identify trends that can improve claim outcomes.

• Monitors assigned queues and duties across various systems (such as, Artiva, HMS, Hyland, BARRT) to ensure all follow-up dates are current.
• 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 all activity accurately and maintaining logs, account notes, and system records.
• Maintains an up-to-date understanding of payer guidelines and requirements related 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 all 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, revenue cycle, or claims denials and appeals processing required
• Prior experience with revenue cycle processes in a hospital or physician office setting required

Requirements

• Strong knowledge of payer guidelines, medical billing practices, and appeal processes.
• Proficiency in relevant software and claim management systems, such as Artiva, HMS, Hyland, 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 Revenue Cycle Specialist (CRCS) - AAHAM preferred