Denials & Appeals Coordinator - REMOTE at Community Health Systems Professional Services Corporation

United States

<p><strong>Benefits</strong></p><ul><li>Comprehensive Health Coverage – Medical, dental, and vision plans to keep you and your family healthy.</li><li>Future Security: 401(k) with matching</li><li>Student Loan Support – Up to $10,000 repayment assistance, because we invest in your future.</li><li>Educational Tuition Assistance</li><li>Competitive Pay &amp; Full Benefits – A salary and package designed to reward your expertise and dedication.</li></ul><p>&nbsp;</p><p><strong>Job Summary</strong><br><br>The Denials &amp; Appeals Coordinator is responsible for managing, tracking, and resolving denials and appeals to ensure timely reimbursement. This role requires in-depth knowledge of payer guidelines, systems, and requirements to navigate complex denial cases effectively, assist in issue resolution, and help identify trends that can improve claim outcomes.<br><br><strong>Essential Functions</strong></p><ul><li>Monitors assigned queues and duties across various systems (such as, Artiva, HMS, Hyland, BARRT) to ensure all follow-up dates are current.</li><li>Analyzes denials to determine appropriate actions, completes appeals, or routes cases for clinical appeals as needed.</li><li>Files and monitors appeals to resolve payer denials, documenting all activity accurately and maintaining logs, account notes, and system records.</li><li>Maintains an up-to-date understanding of payer guidelines and requirements related to denials and appeals.</li><li>Processes BARRT requests, reviews RAC/Government Audit accounts, and completes necessary rebills and adjustments.</li><li>Identifies trends in denials to suggest improvements and reduce future claim issues, providing data for denial and appeal trends as needed.</li><li>Performs other duties as assigned.</li><li>Maintains regular and reliable attendance.</li><li>Complies with all policies and standards.</li></ul><p>&nbsp;</p><p><strong>Qualifications</strong></p><ul><li>H.S. Diploma or GED required</li><li>Associate Degree or higher in Health Information Management preferred</li><li>1-3 years of experience in medical billing, revenue cycle, or claims denials and appeals processing required</li><li>Prior experience with revenue cycle processes in a hospital or physician office setting required</li></ul><p>&nbsp;</p><p><strong>Knowledge, Skills and Abilities</strong></p><ul><li>Strong knowledge of payer guidelines, medical billing practices, and appeal processes.</li><li>Proficiency in relevant software and claim management systems, such as Artiva, HMS, Hyland, and BARRT.</li><li>Excellent analytical skills for reviewing denial trends and suggesting improvements.</li><li>Strong verbal and written communication skills to interact with payers and internal departments.</li><li>Ability to prioritize tasks effectively and manage time in a fast-paced environment.</li></ul><p>&nbsp;</p><p><strong>Licenses and Certifications</strong></p><ul><li>Certified Revenue Cycle Specialist (CRCS) - AAHAM preferred</li></ul><p>&nbsp;</p><p>The Payment Compliance and Contract Management (PCCM) team plays a critical role in ensuring that payments are made according to contractual agreements and regulatory requirements. The team oversees the full contract lifecycle, focusing on analyzing reimbursement discrepancies, improving revenue cycle processes, and ensuring compliance with contract terms to support financial accuracy and operational efficiency.</p><p><br>Community Health Systems is one of the nation’s leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.<br>&nbsp;</p>