DENIALS COORDINATOR

Submit your resume to careers@aergo.com

Please be sure to reference the position in your email.

Essential Duties and Responsibilities:

• • Differentiates between clinical and technical denials through EOB’S, denial letters/payer correspondence and data mining.
  • Identifies payer and hospital’s managed care contracts.
  • Reviews managed care contracts against application of rates, provisions and terms.
  • Reviews timely filing guidelines regarding the appeals process.
  • Contacts payer to negotiate resolution on technical denials.
  • Appeals denials using all means necessary (appeal letters, medical records and other supporting documentation, utilization of on-staff clinicians).
  • Evaluates appeal outcome for next steps (logs recovered funds, supports uphold decision or initiates 2nd level appeal).
  • Manages assigned workload of accounts through timely follow up and accurate record keeping.

Minimum Qualifications & Competencies:

• • Four-year degree preferred or equivalent experience in hospital related billing/follow-up field
  • Benefits/fund administration experience preferred
  • Knowledge of/experience working with managed care contracts
  • Experience working with customer support/client issue resolution management
  • Strong analytical acumen
  • Strong multi-tasking skills
  • Proficiency with MS Office