New

Admitting Denials Coordinator

MedStar Health
United States, Maryland, Columbia
5565 Sterrett Place (Show on map)
May 09, 2025
General Summary of Position MedStar Patient Financial Services is currently seeking an experienced Admitting Denials Coordinator to join our amazing Appeals & Denials team.We are specifically looking for a candidate that has strong skills with investigating and researching claim denials and preparing/writing appeals to get claims paid. Works independently to monitor and resolve denials and write offs received for outpatient accounts. Works in excel creating and maintaining follow up on all accounts. Reports from excel or other format will be required to show progress on receiving reimbursement from insurance companies. Looks for trends of non-payment from payers', provides feedback to outpatient departments with write offs and monitors improvements. Follows accounts to see if we are receiving full payment and trends and tracks revenue opportunities. Provides support for Financial Counselors. Works self pay elective OR accounts, stops cosmetic or sterilization procedures unless paid in cash. Primary Duties and Responsibilities Follows accounts finding opportunities to resubmit for full payment. When full payment hasn't occurred tracks and trends reasons. Monitors for timely follow up. Provides feedback to Access Director of findings. Follows up on accounts insurance cleared by Admitting or PFS. Looks in Siemens to see if there is an authorization and if not responsible party for not having insurance cleared. Uses insurance tools such as HDX, I exchange, Carefirst website and other insurance websites as required. Creates an excel report tracking and trending where responsibility of denial lies. Monitors and works denials report received from PFS. Distributes accounts to outpatient departments responsible for obtaining insurance clearance with expectation that department responds with authorization or reason for no authorization. Tracks and trends all responses from these departments. Monitors for timely follow up. Submits to PFS, authorizations, referrals or other findings that will allow reimbursement to hospital. Creates a report in excel and tracks results of submissions, whether rebilled, past statute of limitations, paid, not paid and reasons. Monitors for timely follow up. Works self pay elective OR accounts, stops cosmetic and sterilization procedures unless paid in cash. Active member of Denials Meeting for MFSMC and PFS Denials Committee. Works with Access and Ancillary Departments to help develop Best Practice". Remains up to date on insurance procedures and benefit changes and attends insurance seminars when available. Provides feedback related to insurance updates and changes to Access Director. Receives PFS Tracking Report and responds with necessary information for timely appeal. Works with the Managed Care Department and insurance companies to resolve insurance payment issues. Submits appeal requests. Assists in writing appeal letters for the appeal teams. Minimum Qualifications Education High School Diploma or GED required Experience 3-4 years experience in medical setting with strong insurance knowledge required Medical coding and denials management preferred Licenses and Certifications CHAA & CRCS-I preferred Knowledge, Skills, and Abilities Abilities Verbal and written communication skills. Basic computer skills with Microsoft Excel required. Working Knowledge in multiple specific payers' application billing and/or collection process. Requires basic working knowledge of UB04 and Explanation of Benefits (EOB). Requires some knowledge of Medical Terminology and CPT/ICD-10 coding. This position has a hiring range of $20.17 - $35.04