Community Health Systems

Compensation

Full Description

Job Description Job Summary 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. Essential Functions • 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 Knowledge, Skills and Abilities • 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