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Denials Management Coordinator in Hendersonville, NC at Adventist Health System

Date Posted: 12/6/2018

Job Snapshot

  • Job Schedule
  • Job Category
  • Date Posted:
  • Job ID:
  • Job Function
    Patient Financial Services
  • Travel
  • Shift
    1 - Day
  • AHS Zone
    1-Shared Services
  • Organization
    Park Ridge Health

Job Description

Park Ridge Health

Park Ridge Health has provided whole-person care to the Henderson County community for more than 100 years. Inspired by our mission of Extending the Healing Ministry of Christ, we continually look for ways to bring hope, health and healing to the patients we have the honor of caring for.  As a member of Adventist Health System, one of the largest faith-based healthcare organizations in the U.S., we also offer world-class opportunities for our team members to learn, grow and serve across the nation.

Work Hours/Shifts

Full time - Days

What you will responsible for:

Reviews insurance claims where payment has been denied.  Conducts extensive investigation of reasons for denial and/or variance pursuing all avenues of appeal to overturn denial.

  • Initiates research with call to insurance company for details regarding denied claim or variance. Understands why denied, what options we have for appeal, and what action is necessary.
  • Demonstrates competency in reviewing medical records and works with hospital staff or corporate managed care to pull the relevant facts together to overturn the denial/variance.
  • Demonstrates ability to compose an appeal letter which clearly states the reason we dispute the denial working independently or with hospital department.  All facts are organized and presented in a professional manner.
  • Ensures that appeals are filed timely and, when necessary, any additional requests for information are submitted promptly.
  • Works follow up list (CFUM) effectively making certain all account activity is current and accounts are not lost due to oversight.
  • Works towards the corporate goal of turning around the denied and/or variance claims and receiving payment in full impacting the scorecard metrics of underpayments and denials.
What you will need:

  • Data entry/basic computer literacy required, specifically Excel.
  • Requires analytical thinking ability and good communication skills both written and verbal.
  • High School Diploma or equivalent required
  • 2 years previous hospital billing experience.

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.


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