Denial and Reimbursement Coordinator (3547)

Job Summary -

The primary responsibility of the Denial and Reimbursement Coordinator is to manage and resolve denied claims and claims processes, including underpaid claims to ensure timely reimbursement and optimal revenue flow for the organization. This role requires a detailed understanding of:

o Insurance policies

o Coding practices

o Appeals processes

o Relevant regulations and tools to drive payment integrity with payers and plans

The coordinator will work closely with the PFS manager healthcare providers, insurance companies, and internal teams to identify denial trends and underpayments, implement corrective actions, and enhance overall claims management processes. The Denials and Reimbursement coordinator reports directly to the Manager of Patient Financial Services.

Regulatory Requirements

· Minimum Education Required: High School graduate or GED.

· Ability to work with internal and external departments in a collaborative manner.

· A minimum of 2 years of related healthcare Revenue Cycle experience, preferably with a focus on denials and reimbursement.

· Strong understanding of healthcare billing, coding and reimbursement processes.

· Experience with Meditech EMR system strongly preferred.

· Relevant certifications (e.g., Certified Revenue Cycle Professional (CRCP), Certified Professional Coder (CPC)) are a plus.

Language Skills

· Ability to communicate in English, both verbally and in writing.

· Additional languages preferred.

· Excellent interpersonal skills.