Denials and Appeals Coordinator

9/2/2022

Position Overview

The Denials and Appeals Coordinator is key the success of the Revenue Cycle because s/he focuses on denials that impact both the revenue cycle at Oregon Oncology Specialists and our patients’ ability to pay for care. The incumbent is responsible for monitoring denials, appeals, and resolutions from participating insurance carriers and working proactively to collect from insurance carriers. The position’s objective is to maximize system efficiencies, reduce operational costs, increase accuracy, and improve reimbursement outcomes.

Essential Job Functions

• Research payer denials related to inaccurate billing and coding, referrals, pre-authorizations, medical necessity, case management, non-covered services, and billing and coding-related issues that result in delayed payments. Initiate best-practice strategies to appeal to insurers in a timely manner.
• Triage accounts in the AR, Coding, and Prior Auth Workflows.
• Submit detailed, customized appeals to payers based on a review of medical records in accordance with Medicare, Medicaid, and third-party guidelines as well as OOS policies and procedures
• Run denials and write-off reports.
• Analyze root causes of denials and present findings to the OOS leadership every week.
• Track recoupment activity and provide regular reports to leadership by department, payor, and resolution reasons.
• Identify resources and work plans required to operationally initiate corrective action plans for identified trends that lead to denials.
• Evaluate workflows leading to denials.
• Create and maintain an organized way for staff /leadership to follow up on outstanding denials.
• Partner with the Revenue Cycle Manager and Team as well as all other departments to pursue all possible efforts to mitigate denials and achieve payments for services rendered or scheduled.
• Serve as the primary resource and contact for internal and external Denial Management resolution and coordination.
• Assist with complex, specialized denial management and follow-up such as those related to clinical trials free drug.
• Provide training to responsible staff which will reduce the risk of denials.

Required Qualifications

• High School diploma or equivalent.
• Two years’ experience in a healthcare revenue cycle role with progressive responsibilities.
• One year of experience managing claim denials and appeals
• Two years’ experience with medical insurance terminology, CPT, ICD coding structures, and billing forms.
• Knowledge of high-functioning EHR, billing systems, and applications (iKnowMed, Lynx, Centricity, Epic, etc.).
• Ability to convey appeal reasoning clearly and persuasively verbally and in writing.
• Ability to logically and accurately analyze details.
• Demonstrated research and resolution related to denial management
• Communicate with multiple levels of internal and external organizations with ease and effectiveness (e.g. physicians, APPs, clinical, management, and support staff).
• Excellent PC operating skills and use of MS Office.

Preferred Qualifications

• Bachelor’s degree in applicable field
• Experience with Oncology billing
• At least three years’ experience demonstrating responsibility for a program or project monitoring and coordination focusing on the revenue cycle of a multi-facility clinic. Experience should include program implementation and evaluation.
• Understanding of Unlimited Systems Revenue Cycle Software

Would you thrive in this position?

• Do you enjoy interacting with a variety of people, making the best of each interaction?
• Are you able to balance focussed priorities with daily urgencies?
• Do you enjoy working in partnerships to accomplish better systems and outcomes?
• Do you enjoy critical thinking?
• Do you have good organizational skills?
• Are you a self-starter who can influence positive change?
• Do you thrive best in team environments?

How to apply:

Email Careers@orcancer.com with the job title in the subject line, and attach your cover and letter and resume.

Please include your experience in the following:

• healthcare revenue cycle: 2 years required
• managing claim denials and appeals: 1 year required
• medical insurance terminology: 2 years required
• EHR or billing systems: 1 year preferred
• oncology billing: 1 year preferred
• Unlimited Systems Revenue Cycle Software: 1 year preferred

COVID-19 Considerations:

OOS is committed to the health and safety of our patients, visitors and employees. PPE is provided and sanitation measures are in place to ensure the safest environment possible.

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OOS is an Equal Opportunity Employer:

Oregon Oncology provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Company complies with applicable state and local laws governing nondiscrimination in employment in every location in which the Company has facilities.