Denials Management Coordinator - On-site

Central Maine Healthcare is an integrated healthcare delivery system serving 400,000 people living in central, western and Midcoast Maine. CMH's hospital facilities include Central Maine Medical Center in Lewiston, Bridgton Hospital and Rumford Hospital. CMH also supports Central Maine Medical Group, a primary and specialty care practice organization. Other system services include the Central Maine Heart and Vascular Institute, a regional trauma program, LifeFlight of Maine's southern Maine base, the Central Maine Comprehensive Cancer Center and other high-quality clinical services.

If you are passionate about making a difference and are looking for your next great career opportunity, we look forward to reviewing your application!

Position Summary:

The Denials Management Coordinator is responsible for applying fundamental knowledge of billing, coding and payer requirements as it relates to researching, analyzing, and resolving denials, contractual underpayments and credits. This job requires regular outreach to payers and internal stakeholders.

Essential Duties:

• Triaging incoming variance inventory
• Validating appeal criteria is met in compliance with departmental policies and procedures
• Composing technical denial language for reconsideration, including both written and telephonic
• Ensuring high level of competence in process and payer knowledge to overcome objections that
prevent payment of the claim
• Gaining commitment for payment through concise and effective appeal composition
• Identifying problem accounts/processes/trends and escalate as appropriate
• Utilizing effective documentation standards that support a strong historical record of actions taken
on the account
• Resolving the account (posting correct contractual adjustments, posting other non-cash related
Explanation of Benefits (EOB) information, updating the patient accounts as appropriate
• Submitting uncollectible claims for adjustment timely and correctly
• Resolving claims impacted by payer recoupments, refunds, and posting errors
• Meeting and maintaining established departmental performance metrics for production and quality
• Maintaining working knowledge of workflow, systems, and tools used in the department
• Practicing and adhering to the Code of Conduct philosophy and Mission and Value Statement
• Maintaining collaborative approach to problem solving working with other revenue cycle teams
and revenue generating areas
• Other duties as assigned
• Resolving accounts to 0 insurance balance
• Completes appropriate actions needed for an effective appeal including conducting authorization
research, rebilling, and balance write off or transfer to next responsible party.
• Utilizes systems, various documents and reports to identify and correct errors accurately and
within established deadlines.
• Escalates issues as appropriate.
• Corresponds with third party payers, hospital departments, and patients to obtain information
required for denial resolution following payer timelines.
• Releases information following Federal, State and Hospital guidelines.
• Uses assigned work queues and prioritization standards and guidelines to perform denial resolution
follow up.
• Uses reference material to troubleshoot payer issues and increase understanding of denial
resolution techniques.
• Reference payer websites as needed.
• Analyzes and researches the denial reasons for each assigned denial code. Determines and executes
the best approach for denial resolution utilizing all available resources.
• Follows payers established procedures and timelines to submit appeals utilizing payers preferred
method, i.e., electronically or via paper.
• Documents all actions taken during the denial resolution process clearly including actions taken,
next steps, payer processing timelines, etc.
• Adjusts account balances using correct transaction code adhering to established departmental
policies.
• Follows established protocols to ensure all documents are retained appropriately Meets established
quality and productivity standards.
• Facilitates and promotes the sharing of knowledge and content throughout departments.
• Follows all established Hospital Billing Revenue Cycle Management departmental and
compliance policies and procedures.
• Participates in cross training of billing resources.
• Demonstrates excellent attendance and actively participates in a variety of meetings and training
sessions as required.
• Maintains and fosters an organized, clean, and safe work environment.
• Contributes to the development and application of process improvements.
• Practices cost containment and fiscal responsibility through the efficient use of supplies,
equipment, time, etc.
• Complies with established departmental policies, procedures and objectives.
• Attends variety of meetings, conferences, seminars as required or directed.
• Demonstrates use of Quality Improvement in daily operations.
• Complies with all health and safety regulations and requirements.
• Respects diverse views and approaches, and contributes in maintaining an environment of
professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.

Education and Experience:

1. 2 Year Degree or 6 years healthcare experience
2. Six or more years of experience in health care billing functions

Knowledge, Skills and Abilities:

• Ability to perform assigned tasks efficiently and in timely manner.
• Ability to work collaboratively and effectively with people.
• Exceptional communication and interpersonal skills.
• Demonstrates ability to organize
• Perform and track multiple tasks accurately in short timeframes
• Able to work quickly and accurately in a fast-paced environment while managing multiple demands
• Able to work both independently and collaboratively as a team player
• Demonstrates adaptability, analytical and problem-solving skills
• Attention to detail
• Ability to engage patients and team members utilizing the CMH Experience Standards

i. I am creating a warming, caring, and non-judgmental environment
ii. I am actively listening and seeking information
iii. I am honest, truthful, and consistent
iv. I am respectful, treating all individuals with dignity and empathy
v. I am serving as a role model, taking both initiative and ownership when appropriate
vi. I am working collaboratively and demonstrating teamwork
vii. I am resilient and adapt to change in positive ways.

• Demonstrated ability to direct and triage in a highly fluid dynamic operational environment.
• Ability to collaborate with all layers of the management/ administration team.

CMH actively promotes diversity in its workforce at all levels of the organization. We strive to create and maintain a setting where we celebrate cultural and other differences and consider them strengths of the organization. CMH is an equal opportunity workforce and no one shall discriminate against any individual with regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, genetic information or veteran status with respect to any offer, or term or condition, of employment. We make reasonable accommodations to the known physical and mental limitations of qualified individuals with disabilities.