Denial Coordinator

Location: Hamilton

Responsible for timely review, resolution, and tracking of assigned claim denials and appeals;identification of recurring denial causes; and coordination of prevention efforts across the revenue cycle. Reviews assigned payment variances against approved payer contract terms and reimbursement methodologies, pursues appropriate recovery, and communicates unresolved discrepancies to leadership. Maintains accurate work queues and reports to support reimbursement,timely filing, and departmental improvement.

Assigned work may include inpatient, swing bed, surgery, outpatient, emergency department, rural health clinic, and professional claims across commercial and government payers. Leadership establishes written payer and service assignments, including ownership of appeals minus traditional

Medicare, clinical appeals, payment variances, and DNFB follow-up.

A. Education High school graduate or equivalent required. Associate degree or coursework in healthcare administration, business, medical billing, or a related field preferred.

B. Job related skills Knowledge of hospital billing, payer requirements, EOBs and electronic remittance advice, claim adjustment and remark codes, and appeal processes. Proficiency with Excel,electronic health records, clearinghouse work queues, and payer portals. Ability to analyze trends,organize deadlines, document findings, and communicate effectively with clinical and administrative teams.

C. Licensure or certification None required. Relevant revenue cycle or billing certification preferred.

Coding certification or clinical licensure is required only when separately assigned duties require that qualification.

D. Experience Minimum one year of hospital revenue cycle experience involving denials, appeals, or insurance follow-up required; two or more years preferred.

Experience with critical access hospital and rural health clinic billing preferred. Independent complex appeals or contract analysis assignments require demonstrated competency and appropriate training.

E. Physical and mental requirements Intermittent walking, sitting, and standing; occasional bending, stooping, reaching, and lifting up to 20 pounds. Ability to concentrate, interpret detailed information, exercise judgment within assigned authority, and manage multiple deadlines. Duties maybe performed with reasonable accommodation.