Role Overview
This position focuses on recovering revenue from denied insurance claims resulting from administrative authorization issues. The Coordinator Denials Recovery investigates the root causes of denials, manages the appeals process, and works to resolve outstanding claims in compliance with payer guidelines and contractual agreements. Close collaboration with internal teams ensures timely collection of necessary documentation and effective communication throughout the appeals lifecycle.
Key Responsibilities
- Identify and track denied claims using data tools and worklists to monitor open cases and follow established resolution procedures.
- Analyze explanations of benefits (EOBs) to detect coding or billing discrepancies and escalate issues to supervisors when needed.
- Review contractual terms and payer policies to assess compliance and determine correct reimbursement methodologies.
- Collect medical records and other supporting documents required to file appeals.
- Update patient accounts with detailed notes on actions taken and outcomes of recovery efforts.
- Apply hospital rate schedules and contractual terms to verify accurate payment amounts.
- Coordinate with departments across the organization to obtain documentation essential for successful appeals.
- Support patients by explaining their financial responsibilities and guiding them through the appeals process when their involvement is necessary.
- Identify patterns in denials to recommend preventive strategies and reduce future claim rejections.
- Maintain professional relationships with internal teams and external partners throughout the recovery cycle.
- Participate in special projects and investigations as assigned by leadership.
Qualifications
A minimum of an associate degree in healthcare, finance, or a related field is required, along with at least two years of experience in a healthcare setting. Familiarity with Soarian is preferred and may enhance performance in this role.
Work Environment
This is an onsite position requiring daily presence at the facility. The work supports a mission-driven environment focused on advancing cancer care and improving patient outcomes.
Organizational Impact
The role contributes to financial integrity by ensuring timely recovery of denied revenue. It also supports broader institutional goals by identifying systemic issues in claims processing and helping refine procedures to improve accuracy and efficiency. The organization is consistently recognized for workplace excellence and innovation in digital health.
