Your job is more than a job

Reporting to the CBO Denials Manager, the Hospital Denials & Appeals Coordinator is responsible for managing denied claims and submitting appeals to the appropriate carrier while identifying and mitigating root cause issues.

Your Everyday

GENERAL DUTIES

Denials Mitigation:

Reviews clinically and technically denied accounts and prioritize cases depending on appeals timelines and dollar thresholds.Maintains accurate, clear, timely documentation related to denied cases.Works collaboratively on reporting trends and root causes and identifies denial avoidance process improvements. Provide results reporting and communication. Track outcomes, share results, identify trends, and present strategies.Resolves denial and appeal complaints from patients, insurance companies and other offices for hospital-related services.

Interdisciplinary Process Improvement:

Works with and educates staff, physicians, and payers on reimbursement issues, clinical protocols/criteria, insurance plan changes, regulations and process improvements.Contacts physician/office staff to retrieve patient information necessary to overturn the denial.Responds to patient and family inquiries regarding denials and serves as a resource, maintains expertise and continues self-education by attending applicable conferences, workshops and meetings.

Denials Tracking & Analytics:

Maintains accurate, clear, timely documentation of processes. Manages denial management database.Tabulates the financial gains of the position and opportunities for improvement by tracking denial overturn/success metrics.Identifies denial avoidance process improvements. Provides results reporting and communication. Tracks outcomes, share results, identifies trends, and presents strategies.Performs reports and audits, works on Special projects, as requested.

IT & Third-Party Payer Relations:

Acts as an additional resource and payor contact.Participates in monthly and quarterly managed care payer meetings.Schedules, coordinates and collaborates with Epic and electronic billing software.Processes, tests, and validates software updates, when needed.

Team Collaboration:

Collaborates with billing, coding, and collections leadership.Provides first-line assistance for claims resolution and provide feedback/education to collection team to improve effectiveness of timely reimbursement.Interacts with various insurance companies, denial vendor partners, electronic billing systems and payer portals.

The Must-Haves

Minimum:

MINIMUM QUALIFICATIONS

Required: High School Diploma/GED or equivalent OR 2 years of work experience in a billing or collections role in a hospital, utilizing electronic patient accounting systems, and managing denials and claims process with knowledge of private insurance and governmental regulations.

KNOWLEDGE, SKILLS, AND ABILITIES

Knowledge of the appropriate use of HCPCS, CPT4, and ICD10 codes.Ability to write clearly and concisely, strong interpersonal communication.Ability to anticipate needs and problems.Analyze and prioritize issues.Ability to provide resolution alternatives.Attention to detail, organized, conflict/problem resolution, effective written and verbal communication, unwavering integrity, confidentiality, and discretion.

WORK SHIFT:

Days (United States of America)

LCMC Health is a community. 

Our people make health happen. While our NOLA roots run deep, our branches are the vessels that carry our mission of bringing the best possible care to every person and parish in Louisiana and beyond and put a little more heart and soul into healthcare along the way. Celebrating authenticity, originality, equity, inclusion and a little “come on in” attitude is the foundation of LCMC Health’s culture of everyday extraordinary

Your extras

Deliver healthcare with heart. Give people a reason to smile. Put a little love in your work. Be honest and real, but with compassion.  Bring some lagniappe into everything you do. Forget one-size-fits-all, think one-of-a-kind care. See opportunities, not problems – it’s all about perspective. Cheerlead ideas, differences, and each other. Love what makes you, you - because we do

You are welcome here. 

LCMC Health is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law.

The above job summary is intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities.  LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary.

 

Simple things make the difference. 

1.    To get started, take your time to fully and accurately complete the application for employment. Incomplete applications get bogged down and are often eliminated due to missing information. 

2.    To ensure quality care and service, we may use information on your application to verify your previous employment and background.  

3.    To keep our career applications up-to-date, applications are inactive after 6 months and, therefore, require a new application for employment to be completed. 

4.    To expedite the hiring process, proof of citizenship or immigration status will be required to verify your lawful right to work in the United States.