Moffitt Cancer Center is seeking a Coordinator Denials Recovery to join our mission to contribute to the prevention and cure of cancer. In this role, you will be responsible for the review and appeal of administrative authorization denials, working to recover critical reimbursement. You will coordinate with appeals and denial recovery specialists for escalated reviews, ensuring we can continue shaping the future we envision.
What You'll Do
- Capture denied dollars through denial management and provider/payer appeals processes.
- Gather data and conduct analysis to identify the root cause of administrative authorization denials.
- Utilize data tools to identify open cases and follow established processes for follow-up.
- Research and resolve denied claims related to authorization.
- Evaluate and understand contractual language and health plan payment policies related to payment compliance, reimbursement methodologies, denials, and appeals.
- Gather necessary medical record documentation to support each appeal.
- Identify coding or billing problems from EOBs and escalate to your supervisor.
- Identify problem accounts and escalate as appropriate.
- Update patient account records to identify actions taken.
- Sort and file correspondence.
- Perform tasks to recover reimbursement for denied claims and document recovery steps in appeals databases and patient accounting systems.
- Determine appropriate reimbursement by applying applicable reimbursement methodology and rate schedules per hospital contractual arrangements.
- Collaborate with various departments to obtain necessary documentation for appeal of denied claims and services.
- Identify opportunities to avoid denials proactively.
- Establish and maintain positive relationships with internal and external customers and within the department.
- Educate, inform, and assist patients to navigate the appeals process, ensuring they understand their potential financial responsibility.
- Perform special projects and investigations as requested by your supervisor.
What We're Looking For
- Associate degree in Healthcare, Finance, or a related field.
- A minimum of two (2) years of related experience in health care.
- Knowledge of third-party reimbursement, charging, and coding guidelines.
- Demonstrated investigational and analytical skills.
- Proven effective communication skills in both written and verbal format.
- Exceptional attention to detail and demonstrated ability to prioritize work.
Nice to Have
- Experience with Soarian.
Moffitt Cancer Center is an equal opportunity employer.
