AdventHealth seeks to hire Denial Management Coordinator who will embrace our mission to extend the healing ministry of Christ.
Established in 1908, AdventHealth is one of the largest not-for-profit healthcare systems in the country, caring for more than a million patients each year. The Maitland Office Plaza houses our highly skilled teams that support our hospital system including Marketing, Patient Financial Services, Revenue Management, the Credit Union and Human Resources. The Trickel Building, a two-story office structure, creates an atmosphere of health and healing, with a healthy-style caf? and quaint chapel. The main lobby is filled with lush greenery and a light trickle of water, creating a holistic environment.
Days and Hours Flexible
Under supervision of the Director of Utilization Management, the Denial Management Coordinator is responsible for processing and documenting pertinent electronic authorization and denial communication from insurance/payors for the Central Florida Division- South Region. Maintains close working relationships with the Utilization Management Authorization Representatives and Utilization Management Nurses to expedite concurrent denials and work flow. Anticipates and responds to inquiries and needs of team members and Revenue Management partners as requested. Manages multiple clerical duties and assigned projects, while sustaining the department's key initiatives in support of daily operational workflow and special projects, as required. Adheres to the rules and regulations of all commercial and government payers in fulfilling daily work assignments. Supports the Utilization Management Coordinators, as needed. Supports the AdventHealth Utilization Management Plan for the Central Florida Division- South Region. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
+ Understanding of HIPAA privacy rules and ability to use discretion when discussing patient related information that is confidential in nature.
+ Working knowledge of Microsoft programs, familiarity with database programs, and understanding the PDF process.
+ Ability to operate general office machines such as computers, facsimiles, copiers, and scanners.
+ Ability to effectively learn and perform multiple tasks and organize work in a systematic and efficient fashion in a fast-paced environment.
+ Self-motivated and able to work with teams across the Central Florida Division- South Region.
+ Ability to prioritize and problem-solve skills and work within very tight time frames.
+ Ability to communicate professionally and effectively in English, both verbally and in written form.
+ Analyze insurance/denial related issues within the department and effectively communicate to the team what needs to be addressed.
+ Interpersonal skills to promote teamwork.
+ Ability to be responsive to an ever-changing matrix within the hospital.
+ Proficient in Microsoft Word, Excel and Outlook. (Preferred)
+ Proficient in Cerner applications. (Preferred)
+ Basic knowledge of medical terminology. (Preferred)
+ Exposure to insurance benefits and ability to decipher insurance benefit information. (Preferred)
+ Associate degree and/or higher-level education, or completed coursework, in Health Services Administration or other related medical or business field (Preferred)
+ Experience in health care, hospital setting, and/or Patient Finance Services (Preferred)
**Licensure, Certification, or Registration Required:**
Demonstrates through behavior AdventHealth's Core Values of Keep Me Safe, Love Me, Make it Easy, and Own it as outlined in the organization's Performance Excellence Program.
+ Responsible for monitoring and addressing electronic faxes and mail from health plans and third-party payers. Forwards communication to appropriate Utilization Management team member.
+ Enters pertinent denial information into the appropriate computer programs for UM team members to review and address in a timely manner. This includes, but is not limited to, entering denial details in Cerner Registration Conversations, Cerner Patient Accounting, updating UM fields in Cerner Care Management, and uploading denial correspondence into Cerner.
+ Monitor the Denial Phone Line for the Central Florida Division- South Region, which serves as the official phone number for telephonic authorization and denial information from Health Plans.
+ Manage and monitors mail from the department mailbox, which includes uploading letters from Health Plans to patient encounters and forwarding correspondences to applicable Departments.
+ Acts as a liaison between Health Plan Reviewer, PFS (Patient Financial Services), and Pre-Access, working closely with the UM Authorization Representatives and Lead.
+ Track and trend payor issues and potential contractual issues and escalate to UM leadership for resolution.
+ Supports the Utilization Management Support Specialists when needed based on staffing and/or work flow.
+ Manages multiple clerical duties and assigned projects, while sustaining the department's key initiatives in support of daily operational flows and special projects as required. Attends inter-departmental meetings as requested by the Director. Assist UM Management and other duties, as needed.
If you want to be a part of a team that is dedicated to delivering the highest quality in patient care, we invite you to explore the Denial Management Coordinator opportunity with AdventHealth and apply online today.
We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.