The Claims Coordinator is responsible for directing, coordinating and assuring timely, accurate, efficient and compliant processing of the denial process. Coordinate and assure daily denial management process. Monitor and identify payer plan billing requirements as needed to reduce/prevent denials. Monitor reports, identify denial issues and assure appropriate reprocessing of claims. Supervise monitoring of denial management worklist; assure accurate reimbursement, coordinate necessary correction activity/change requirements. Report back to department number of denials, denial reasons, and areas of opportunity on a monthly basis. Maintain current knowledge of billing, reimbursement and compliance requirements, and assure education of staff if needed. Effectively represents the hospital and Business Services as a resource person for the denial process. Evaluate system activity and work with Supervisors, Manager, and Business Services Analyst by creating new rules or modifying existing rules to streamline the denial process. Monitor system trends, identify areas of opportunity and report back to supervisors or manager to increase revenue and system efficiencies. Recognizes and determines specific claim details and carrier requirements, to increase revenue and minimize denials. Coordinate and monitor claim processing with electronic billing representatives. Plays an active role in encouraging and communicating community development internally and externally. Performs other related work and support activities as needed.
QUALIFICATIONS AND REQUIREMENTS:
Education: High school diploma or equivalent required.
Experience: Current knowledge and extended experience relating to medical/hospital claims processing and compliance requirements preferred.
Level of Business Knowledge/Knowledge/Skills/Abilities: Medical terminology/Clerical/Customer Service required. Electronic billing experience required. Ability to read/understand an EOB/Denial. Strong computer skills required.
At Virginia Mason Memorial, our vision is to "create healthy communities one person at a time." This means that each member of our award-winning team works to provide our patients, and their families, with the best medical and individual care possible.
Why do we do what we do? As the region's leading health care provider and Yakima's largest employer, we believe that by improving health, we will transform Yakima! We work together to demonstrate our values of Respect, Accountability, Teamwork, Stewardship, and Innovation for everyone who walks through our doors, patients and coworkers alike. Does this sound like the place for you? We would love to hear from you! Come be the best of the best with us!
We offer competitive benefits and compensation, including a generous 401K plan, medical, dental, vision, and life insurance, an employee wellness clinic and leadership development and education.
"Yakima Valley Memorial Hospital provides reasonable accommodations to assist qualified individuals in order to perform the essential duties/requirements their job requires. The description is intended to provide only basic guidelines for meeting job requirements and serves as merely a summary rather than a complete listing of duties. Responsibilities, knowledge, skills, abilities, and working conditions may change as needs evolve. This job description does not constitute a contract as employment is at will."
Configurated Hours: Configuration 40 hour work week - Overtime accrues when working over 40 hours in a Sunday - Saturday work week
Location: Yakima, WA
Application Method: Online
Base Pay: DOQ