Denial and Appeals Coordinator

Overview

Job Description - Denial and Appeals Coordinator Full Time (550050). Denial and Appeals Coordinator Full Time. Muskogee Area.

At Scion Health
, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.

Job Summary

• The Denials & Appeals Coordinator serves as the operational driver for timely and effective denial management, working closely with other members of the team, especially utilization management, to ensure no step is missed in preventing and resolving authorization-related denials. While not a clinical role, this position is critical in executing the processes that protect revenue and keep patient care moving forward.
  
  Focused on denial prevention, the Denials & Appeals Coordinator monitors the concurrent review process for continued stay authorizations, tracking potential issues and ensuring timely follow-up for designated facilities. This role actively tracks, organizes, and reports denial activity, partnering with case management teams, the Centralized Business Office, managed care, facility controllers, Clinical Denials Management, and Regional leadership to ensure alignment and swift resolution.
  
  By acting as a central point of coordination and follow-through, the Denials & Appeals Coordinator turns strategy into action—ensuring tasks are completed, deadlines are met, and communication flows between all parties. This role demonstrates accountability, attention to detail, and a commitment to quality improvement, problem solving, and productivity enhancement in an interdisciplinary model.

Essential Functions

• Serves as key team member of the new Central Access and Authorizations Team (CAAT), serving as a subject matter expert on denial prevention and coordination.
• Works with facility to gather clinical information from medical record. Responsibility may include printing and scanning into required systems.
• Ensures all denial-related documentation is complete, accurate, and submitted within required time frames
• Collaborates with other members of the CAAT, Business Development, Case Management, and Clinical Teams in denial management process
• Coordinates and schedules peer to peer physician consults as needed; may work with case management if attending physician is completing peer to peer, or may work directly with physician advisory group to schedule
• Monitors and tracks insurance denials; identify trends in the data
• Communicates authorization outcomes to appropriate personnel (hospital and Centralized Business Office)
• Manage the denial root cause analysis efforts as requested; including
  • Capturing lessons learned
  • Identifying training opportunities
  • Providing appropriate communication and follow up to the teams