The position will support the leadership that addresses management and reporting of denials, appeals, and observation cases under the direction of the Chief Revenue Officer. The Clinical Denials/ Appeals Coordinator will apply expertise in revenue cycle operations and technology, to support data integrity and the management and tracking of revenue and denials for the medical center. Position will be responsible to optimize the automation and utilization of revenue cycle tools such as Cobius, and... more details
Position Summary
The position will support the leadership that addresses management and reporting of denials, appeals, and observation cases under the direction of the Chief Revenue Officer. The Clinical Denials/Appeals Coordinator will apply expertise in revenue cycle operations and technology, to support data integrity and the management and tracking of revenue and denials for the medical center. Position will be responsible to optimize the automation and utilization of revenue cycle tools such as Cobius, and leverage data analysis and reporting for the organization.
Primary Position Responsibilities
Responsible for maintaining data within Cobius Audit Manager, including, but not limited to, updating records with validation and maintenance of audit status (open/closed), denial(s) appeal level; revenue received on claims; etc.
Utilize effective critical thinking skills to analyze regulatory requirements, revenue cycle processes, governmental and commercial insurance rules, and processes for billing and appeals as a means to implement process improvements; analyze and interpret findings and design and create management reports.
Monitor and track key performance indicators related to revenue cycle and denials. Responsible for interpreting and communicating complex data findings to key stakeholders in a clear and concise manner. Findings will include trends, patterns, anomalies related to the overall revenue life cycle.
Ensure data accuracy and integrity of Cobius by implementing rigorous data cleansing and validation processes. Responsibility includes the monitoring and validating of data from various internal and external sources.
Work closely with third party vendors, IT, and internal revenue cycle teams to resolve data quality issues. Analyze payment and realization trends using insurance claim data and manage dashboard and reports that provide actionable insights for revenue cycle stakeholders. Collaborate with revenue cycle, finance, and operational teams to understand the business requirements and goals for Cobius data management.
Serves as liaison with insurance payers regarding delayed responses to appeals and audits. Responsible for all correspondence (email; fax; mail) related to audits/denials – tracking and follow up with internal stakeholders and governmental and commercial payors. Ensure all relevant documentation is provided to payers in a timely manner. Provide data support for strategic initiatives and projects.
Perform other duties within the revenue cycle department as assigned.
Qualifications
Minimum Education:
Required:
Bachelor’s degree in Business, Finance, Healthcare Administration, Data Science, Analytics or related field.
Preferred:
Masters’ degree in Business or Analytical Sciences or related field
Minimum Years of Experience (Amount, Type and Variation):
Required:
Minimum of 2 years previous business analyst or data integrity experience required
Preferred:
3 – 5 years previous business analyst or data integrity experience required
License, Registry or Certification:
Required:
None
Preferred:
Coding certification or completion of coding certification class
Knowledge, Skills and/or Abilities:
Required:
Proven experience in data and financial analysis required
Proficiency in database and spreadsheet tools/products including advanced skills in pivot tables, v-lookups, index/match functions
Experience working with disorganized data from various sources and translating into practical insights and recommendations required.
Ability to deal with ambiguity and confidence to ask critical questions in order to problem solve issues required.
Strong proficiency in data analysis tools and languages required
Familiarity and working knowledge of healthcare revenue cycle processes and regulations required.
Excellent communication and presentation skills required
Ability to work independently and collaboratively in a team environment required
Attention to detail and a commitment to delivering high quality and accurate results required.
Preferred:
Previous experience in a healthcare setting; experience with business intelligence and data visualization tools; previous experience with claims data, diagnostic/procedural data; an understanding of payer policies regarding appeals and deadlines; an understanding of medical records, insurance terms, and payment methodologies.
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