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Full-time
high school, associate degree
Posted 6d ago
~40 hrs/week
Responsibilities
The Denials and Appeals Coordinator manages, tracks, and resolves insurance denials to ensure timely reimbursement while identifying trends to improve future claim outcomes. They also serve as a subject matter expert, providing training and collaborating with revenue cycle vendors to maintain compliance.
Requirements
Candidates must have at least 5 years of experience in hospital billing or revenue cycle management and a high school diploma or GED. Proficiency in medical billing software and strong knowledge of payer guidelines are essential for this role.
Full job description
Description
Job Summary:
The Denials & 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.
Supervisory Responsibilities:
May have direct reports
Serves as back-up to the Director of Revenue Cycle
Duties/Responsibilities:
Monitors assigned queues and duties across various systems, to ensure all follow-up dates are current.
Analyzes denials to determine appropriate actions, completes appeals, or routes cases for clinical appeals as needed.
Files and monitors appeals to resolve payer denials, documenting all activity accurately and maintaining logs, account notes, and system records.
Collaborates with Revenue Cycle vendors.
Serves as key team member and subject matter expert on denial prevention and coordination.
Identifies training opportunities.
Able to prepare training documents, education and/or presentations for Business Office staff and department leaders as needed.
Maintains an up-to-date understanding of payer guidelines and requirements related to denials and appeals.
Processes internal requests, reviews Government Audit accounts, Payer refund requests related to overpayments and completes necessary rebills and adjustments.
Identifies trends in denials to suggest improvements and reduce future claim issues, providing data for denial and appeal trends as needed.
Assist with, complete, and provide coding and billing documentation to ensure accurate coding and billing practices to maximize revenue and minimize claim denials.
Answer inquiries from patients.
Maintain compliance with relevant regulations, including HIPAA, and payer-specific guidelines
Perform other related duties to benefit the mission of the organization.
Requirements
Required Skills/Abilities:
Strong knowledge of payer specific guidelines, medical billing practices, and appeal processes and medical technology
Able to assist in or lead training of other revenue cycle staff as needed
Attend leadership meeting related to Revenue Cycle for both Clinics and Hospital.
Able to provide appropriate communication and follow-up to the teams
Proficiency in relevant software and claims management systems, such as Meditech, Quadax and Athena a plus
Excellent analytical skills for reviewing denial trends and suggesting improvements
Strong verbal and written communication skills to interact with payers and internal departments
Ability to prioritize tasks effectively and manage time in a fast-paced environment
Intermediate computer skills, including but not limited to: Microsoft Office, electronic medical record, and email
Strong command of / proficient in spoken and written English
Strong attention to detail
Ability to multi-task with multiple interruptions
Education and Experience:
Highschool diploma or GED required; Associate Degree or higher in Health Information Management preferred
5+ years of experience in hospital billing, revenue cycle, or claims denials and appeals processing require
Prior experience with revenue cycle processes in a hospital required. Physician practice experience a plus
CPC a plus
Physical and Mental Requirements:
Prolonged periods sitting at a desk and working on a computer
Must be able to lift up to 25 pounds at times
Must be able to navigate various departments of the organization’s physical premises
Sufficient hearing, vision, and dexterity to perform duties safely
Stress Level: Low to Moderate
OSHA Classification:
Category III: Tasks that involve no exposure to blood, body fluids, or tissues, and Category I tasks are not a condition of employment.
The normal work routine involves no exposure to blood, body fluids, or tissues (although situations can be imagined or hypothesized under which anyone, anywhere might encounter potential exposure to body fluids). Persons who perform these duties are not called upon as part of their employment to perform or assist in emergency medical care or first-aid or to be potentially exposed in some other way. Tasks that involve handling implements or utensils, use of public or shared bathroom facilities or telephone, and personal contacts such as handshaking are Category III tasks.
Here at GRMC, we understand the importance of keeping our community healthy. That’s why we’re working to be the very best place for patients to receive care, employees to work and physicians to practice medicine. In fact, that’s our Mission! Come see why we’re ranked among the top Texas hospitals in terms of patient satisfaction and quality. We are making it even easier to interact with Graham Regional Medical Center!
Based on 2104 listings with disclosed salaries, most administrative jobs in Texas pay between $48k–$97k per year. Individual offers vary with seniority, company size, and specialization.
How many Administrative jobs are open in Texas right now?
There are currently 23,299 open administrative positions in Texas listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Administrative roles in Texas?
Companies currently hiring include Prairie View A&M University, Texas Health and Human Services, UTMB School of Health Professions, University of Texas Southwestern Medical Center, Aiken Regional Medical Centers, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Administrative jobs in Texas?
Yes — 2783 of the 23299 open administrative positions offer remote or hybrid work (942 remote, 1841 hybrid).
How do I apply for Administrative jobs in Texas?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.