Denial & Appeals Coordinator
- Job Title
- Denial & Appeals Coordinator
- Job ID
- Washington, DC 20060
- Other Location
With over 150 years of caring for our community and each other in the Washington DC area, Howard University Hospital has a world-renowned reputation for high-quality, patient-centric care. Howard University Hospital is the nation’s only teaching hospital located on the campus of a Historically Black University and has created a superior learning environment, with groundbreaking research and positive patient outcomes.
Howard University Hospital seeks to hire an Denial and Appeals Coordinator who will embrace our reach and historic tradition of excellence. If you want to make a difference in someone’s life every day, consider a position with a team of professionals who are doing just that, making a difference.
The Denial and Appeals Coordinator:
The Denial & Appeals Coordinator is responsible for denial and appeals claim processing for medical providers, facilities and laboratories, ensuring compliance and contractual obligations and State and Federal laws and regulations and generating appeals for denied or underpaid claims.
- Validate denial/code reasons following explanation of benefit (EOB); review and ensure coding is accurate and reflects procedures billed.
- Analyze all coding adjustments made on EOB to ascertain accuracy and valid support
- Review Summary Plan descriptions and related insurance documents to ascertain benefits
- Determine and execute best approach for denial resolution and processing appeal
- Ensure timeliness of all appeals according to Federal, State and plan guidelines
- Generate appeals based on the dispute reason(s)
- Document all actions taken during the appeal process and any follow-up required
- Request and obtain medical records, notes and/or copy of claim as appropriate
- Resolve appeal claims with third party payers
- Assist with Appeals Team efforts to coordinate problem solving in an efficient and timely manner
- Assumes other duties and responsibilities that are related and appropriate to the position and area. The above responsibilities are a general description of the level and nature of the work assigned to this classification and are not to be considered at all-inclusive.
Qualified candidates will possess:
- High School diploma and/or equivalent education
- 3+ years of medical appeals/medical coding experience
At Howard University Hospital our job is to care for you. We do this by offering:
Work life balance
Recognition and rewards for professional expertise
Competitive, comprehensive benefit plans offered (including health, disability, vacation, sick leave, and 403B retirement plan)
- Required Skills