Denial Mgmt Coordinator - PA/PFS Park Ridge Health
Park Ridge Health has provided whole-person care to the Henderson County community for more than 100 years. Inspired by our mission of Extending the Healing Ministry of Christ, we continually look for ways to bring hope, health and healing to the patients we have the honor of caring for. As a member of Adventist Health System, one of the largest faith-based healthcare organizations in the U.S., we also offer world-class opportunities for our team members to learn, grow and serve across the nation.
Reviews insurance claims where payment has been denied. Conducts extensive investigation of reasons for denial and/or variance pursuing all avenues of appeal to overturn denial.
- Initiates research with call to insurance company for details regarding denied claim or variance. Understands why denied, what options we have for appeal, and what action is necessary.
- Demonstrates competency in reviewing medical records and works with hospital staff or corporate managed care to pull the relevant facts together to overturn the denial/variance.
- Demonstrates ability to compose an appeal letter which clearly states the reason we dispute the denial working independently or with hospital department. All facts are organized and presented in a professional manner.
- Ensures that appeals are filed timely and, when necessary, any additional requests for information are submitted promptly.
- Works follow up list (CFUM) effectively making certain all account activity is current and accounts are not lost due to oversight.
- High school diploma or equivalent required.
- 2 years’ previous hospital billing experience required