HIM Denials Coordinator
Job DescriptionThe Health Information Management (HIM) Denials Coordinator is responsible for the ongoing and proactive coordination of appeals processes and CMS related regulations. The coordinator will communicate directly with all appropriate departments including Case Management, Coding, Business Office, Revenue Integrity, and Finance. This position is responsible for assuring timely and synchronized responses to Commercial and Government audit requests and maintains reports which accurately track all requests, correspondence, actions and outcomes. This position requires effective communication with all stakeholders and excellent organization skills to ensure timeliness and accuracy of response requests, as well as continual program development through training and process improvement. The Coordinator must develop subject matter expertise on assigned core business areas, including but not limited to a thorough understanding of available software and data analysis and reporting.
- Assists in preparation of policies and procedures to guide the RAC audit process for the facility and providers.
- Creates a meaningful dashboard of the key indicators regarding the Commercial and Government
- audit process and submits at required time frames to assist with assessing risk and measuring performance of the RAC management program.
- Develops formal communication plan to ensure timely and appropriate action on Commercial and Government
- requests, denials, and appeals.
- Participates in departmental process improvement initiatives, works on special projects as needed, and attends all departmental meetings.
- Acts as a liaison between Administration, Compliance, Business Services, HIM, Revenue Integrity, Case Management, and other applicable departments. Provides monthly reports related to Commercial and Government activity and identified patterns and trends.
- Evaluates the Commercial and Government audits workflow on a continuous basis identifying opportunities to streamline and improve performance.
- Coordinates and manages multiple denial projects, in varying stages of appeal, based on input from multiple stakeholders, according to specified time frames as well as related regulations.
- Reviews requests and assesses, with various departments, the appropriate action based on reason for request such as medical necessity, level of care, coding, and documentation. Coordinates the necessary follow-up activities and assists departments as appropriate.
- Performs other duties as assigned.
- Uses spreadsheets and database software applications for denial management case analysis, data mining, reporting key information to departments and executive leadership, and tracking the status of each case at the encounter level to insure all deadlines are met.
- Oversees and coordinates the processes of responding to Commercial and Government audit reviews in the form of satisfying initial medical record requests, logging in correspondences, and tracking responses.
- Develops a thorough understanding of available software for tracking and trending data for Coding and CDI.
- Prepares data analysis and reporting for department leadership on a regular basis.
- Supports other projects and duties as assigned.
Associates OR HS Diploma/GED and 4 additional years of experience.
3 years’ experience
Must be Licensed in a clinical discipline (such as LPN), or certified as a Health Information Technician (RHIT, RHIA) or Coding Professional (CCS, CCS-P, CPC, CPC-H).
-Must possess a knowledge of ICD-10CM, CPT, and MS-DRG/APC classifications and reimbursement methodologies, as well as strong verbal and written communication skills.
-Knowledge in data management for report writing and tracking, using computerized systems for health information storage and retrieval, and with paper, computerized, and hybrid medical records.
-Must be proficient in Microsoft Word, Excel, and Power Point.