Denial Coordinator

Cone Health

United States, North Carolina, Greensboro

Apr 16, 2025

The Denial Coordinator is responsible for verifying the validity of claim denials in comparison to Medicare Regulations, Managed Care Contract and Reimbursement Calculators. This role tracks and monitors requests for records and denials maintaining current activity on each recovery and denial record providing essential quality evaluation reports, advice and improvement recommendations. This job manages the appeals process to achieve timely denials resolution and maintains current denial and recovery records and also provides ongoing feedback to stakeholders related to denial trends and participates in denial reduction initiatives.

Initiates denials process, including appeals and status requests, same day as receipt of notification, including proactive coordination of fact-finding and intervention with and interaction between payers, regulatory bodies, medical staff, and Health System personnel.
Identifies cases for potential denial and utilizes the organization's electronic systems and medical record, in addition to gathering information from appropriate department staff, to avoid a denial determination.
Performs documentation and analysis of denials, appeals and status information.
Monitors appealed denials to ensure timely payment or rejection of the appeal.
Enters required information into the tracking system upon receipt of denial or request from Payor/Contractor.
Prepares monthly organization denials reports to be communicated in Denials Meetings.
Participates and leads discussions with payors related to resolution of complex claims and reimbursement policy changes.
Performs other duties as assigned.

EDUCATION:

Required: Associates Degree (will accept certification in lieu of degree)
Cert Required in lieu of degree: Certified Revenue Cycle Representative (CRCR) or comparable certification through American Association of Healthcare Administrative Mgmt. with 7 years experience

EXPERIENCE:

Required: 5 years of experience

LICENSURE/CERTIFICATION/REGISTRY/LISTING:

Equal Opportunity Employer At Cone Health, we strive to create a welcoming atmosphere that celebrates a diverse and unique workforce. We believe in offering equal opportunities for employment to all applicants and employees, regardless of their race, religion, age, sex, sexual orientation, gender identity, veteran's status, ethnicity, national origin, disability, color, or any other characteristic protected by law. Our hiring and employment choices are based on each individual's qualifications, skills and performance. We believe that by embracing the diversity of our team, we can better serve our patients, communities and each other.