Corewell Health
Finance / FinServ
DenialsCoordinator
Neural analysis suggests this role is
optimal for Mid candidates.
“Denials Coordinator at Corewell Health. Skills: Denial Management, Revenue Cycle Management, Patient Financial Services. Ensures that timely, accurate and complete data is submitted to appropriate insurance companies to guarantee prompt payments. Review all accounts that have a payer denial based on the Denial Management Policy and Procedure and take appropriate action based on the type of denial”
What You'll Achieve.
Ensures that timely, accurate and complete data is submitted to appropriate insurance companies to guarantee prompt payments to Corewell Health.
Industry & Context.
Utilizes critical thinking skills to manage an ever-evolving process that includes financial, clinical and medical/legal components; Identifies and corrects weaknesses in the process and alerts management in the event of potential technical denials due to not meeting date sensitive deadlines
MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category
What They're Looking For.
Must Have
3 years of relevant experience or more working in patient financial services, revenue cycle, or similar field
What You'll Do.
accurate and complete data is submitted to appropriate insurance companies to guarantee prompt payments
Review all accounts that have a payer denial based on the Denial Management Policy and Procedure and take appropriate action based on the type of denial
Documents all necessary reason for denial/audit
action taken in the electronic medical record per denial management policy
Apply corrections to patient demographics
and payments or when needed forwards to the appropriate department for correction
Appeal denials based on the appeal criteria found within the Denial Management policy and within appropriate denial due date timeframes
Follows payor or contractor denial/audit rules and timelines as outlined
Performs appropriate follow up with payors on status of appeals/audits
Follows appropriate next steps when denial has been upheld and completes correct adjustment process after the first level of denial is upheld
Inputs data from various sources (insurance companies
and other hospitals) into Care Management discharge planning software and insures communication to members of Care Team
Processes and prepares clinical reviews completed by Care Management Department (CMD) employees for confidential transmission to third party payers
Maintains ongoing communication between Corewell Health (CH) and third-party payers related to the number of hospital days authorized
additional requests for clinical information
anticipated discharge needs
Supports specific third-party payers by obtaining authorization for providing accurate & timely admission/discharge updating CMD and SH employees on any demographic problem solving issues/concerns third party payers
Maintains expert knowledge of post payment audit and denial issues
Stays current on trends related to medical necessity
diagnosis-related group (DRG)
and automated denials by the recovery audit contract (RAC) and MIP by attending conferences
audio conferences and online study
Utilizes department specific as well as external software applications determined by management to maximize efficiency and effectiveness of department workload
Develops and maintains databases
Maintains a fast-paced process of requests and acknowledgements for data and correspondence
Identifies and corrects weaknesses in the process and alerts management in the event of potential technical denials due to not meeting date sensitive deadlines
Maintains an understanding of many complex and varying guides
regulations and tools
Develops and implements effective support systems to ensure accurate documentation
Ensures availability of all reports and records for area of responsibility
Prepares reports of post payment audit findings and recommendations for management
Maintains electronic records of audits
issues and investigations in accordance with departmental practices
Assists in the compilation and production of reports to the Corewell Health Denials Steering Committee
Makes sure account activity is tracked
updating systems/spreadsheets on a regular basis to ensure proper tracking and follow-up
Coordinates workflow and deadlines with other hospital departments and outside vendors
Performs scheduled reconciliation of the tracking tool to ensure all deadlines are met
manager and leadership to develop and revise policies and procedures related to post payment audits
Presents post payment audit findings to Denials Steering Committee and Post Payment Audit Workgroup as needed
Actively participates in safety initiatives and risk mitigating measures where appropriate and completes all position and unit safety related competencies and requirements on a timely basis
How You'll Work.
Team & Collaboration
Communicates and collaborates with the multidisciplinary team through verbal and written communication; Participates with Care Team for the integration of the patient to the home or transitional environment; Work with facility departs when necessary for resolution or appeal of denials related to that department (i. e Lab, Patient Access, Case Management); Inputs data from various sources (insurance companies, admissions, certification, and other hospitals) into Care Management discharge planning software and insures communication to members of Care Team; Maintains ongoing communication between Corewell Health (CH) and third-party payers related to the number of hospital days authorized, additional requests for clinical information, anticipated discharge needs, etc.; Supports specific third-party payers by obtaining authorization for providing accurate & timely admission/discharge updating CMD and SH employees on any demographic problem solving issues/concerns third party payers; Coordinates workflow and deadlines with other hospital departments and outside vendors
Communication Scope
verbal and written communication
Process & Methodology
Develops and implements effective support systems to ensure accurate documentation, Ensures availability of all reports and records for area of responsibility, Prepares reports of post payment audit findings and recommendations for management, Maintains electronic records of audits, issues and investigations in accordance with departmental practices, Assists in the compilation and production of reports to the Corewell Health Denials Steering Committee, Makes sure account activity is tracked, updating systems/spreadsheets on a regular basis to ensure proper tracking and follow-up, Performs scheduled reconciliation of the tracking tool to ensure all deadlines are met
Full Job Description
## ## **Job Summary** Ensures that timely, accurate and complete data is submitted to appropriate insurance companies to guarantee prompt payments to Corewell Health. Communicates and collaborates with the multidisciplinary team through verbal and written communication. Participates with Care Team for the integration of the patient to the home or transitional environment by developing, planning, implementing and evaluating in accordance with current existing federal, state and local standards. Adheres to confidentiality policies specific to communications, patient confidentiality, record keeping and coordination services. ## **Essential Functions** * Understanding of the revenue cycle and the responsibility and goals of each area and how they impact the revenue cycle. * Review all accounts that have a payer denial based on the Denial Management Policy and Procedure and take appropriate action based on the type of denial. * Documents all necessary elements; reason for denial/audit, denial status, action taken in the electronic medical record per denial management policy. * Understanding of current payer contracts. * Apply corrections to patient demographics, charges, adjustments, and payments or when needed forwards to the appropriate department for correction. * Identify and provide communication and education on trends identified. * Appeal denials based on the appeal criteria found within the Denial Management policy and within appropriate denial due date timeframes. * Work with facility departs when necessary for resolution or appeal of denials related to that department (i.e Lab, Patient Access, Case Management). * Prepare and distribute a monthly denial log by facility to include account number, payor type, reason for denial when requested. * Identifies and communicates monthly denial trends and provides education as necessary to avoid recurring denials for the same denial reason code. * Send identified medical records as part of the denial/audit process via var
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