Hospital Corporation Of America (HCA) Denial Coordinator Inpatient in Denver, Colorado

Job Code: 03174-76919 Full-time No Weekends JOB TITLE: Denial Coordinator - InpatientGENERAL SUMMARY OF DUTIES: Manage Authorization and Denials to prevent noauthorization denials. Set up Peer to Peers.SUPERVISOR: Manager of Denial CoordinatorDUTIES INCLUDE BUT ARE NOT LIMITED TO: * Review Right Fax box for Denials enter data in auth/cert gridscan into patient s account in OnBase * Review Right Fax box for authorizations enter data in auth/certgrid scan into patient s account in OnBase * Send Insurance Case Managers discharge summary to close out case oncepatient discharges * Review for patient Level of Care to assure we agree with and arebilling what was authorized * Review auth required active report * Review auth required discharge report * Fax clinicals this only includes signed H & P, signed OPSreport, signed Progress Notes, signed Discharge summary * Check various payer Portals for authorization in writing and scan intothe patient s accounts in OnBase * Set up Peer to Peers * Monitor the outcome of the Peer to Peers * Escalate Peer to Peer decisions that are upheld to Division if we arenot in agreement with decision * Review the Medicare Part B report to determine if additionalauthorization is required * Review the Mom s report to determine if 48/96 rule has been met andif notification and authorization is required * Escalate all pending discharged accounts 14 days to Division * Attend monthly/bi-monthly DMAT meetings and Low $ denial meetings * Attend in house high $ review weekly (if applicable) * Review O/P s and SDS patients who convert to OBS to assure that SDSauth follows the record * Send clinicals to OOS Blue Cross plans * Review United/Kaiser portal on longer LOS patients to determine thatall days have been approvedKNOWLEDGE, SKILLS & ABILITIES: * Ability to effectively communicate both verbally and in writing. * Proficient in Microsoft Office applications, Internet searches, andrelevant data bases (OnBase, ARTIVA, Meditech, MIDAS, HPF). * Ability to work independently and under pressure to follow through onissues. * Ability to establish and maintain long-term customer relationships,building trust and respect by consistently meeting and exceeding expectations. * Ability to work effectively with other employees and external parties. EDUCATION * High school educationEXPERIENCE * Minimum of 3-5 years of PTAC experience preferredPHYSICAL DEMANDS/WORKING CONDITIONS * Requires prolonged sitting, bending, stooping and stretching. * Requires eye-hand coordination and manual dexterity sufficient tooperate a keyboard, photocopier, telephone, and other office equipment. * Requires normal range of hearing and eyesight to record, prepare andcommunicate appropriately. * Requires lifting up to 20 pounds occasionally. * Work is performed in an office environment. * Work may be stressful at times. * Contact may involve dealing with angry or upset people. Last Edited: 01/04/2019Diversity is valued and actively promoted in the workforce at all levels. Westrive to celebrate cultural and other differences and consider them strengthsof the organization.We are committed to:Providing an inclusive work environment where everyone is treated withfairness, dignity and respect.Recruiting and retaining a diverse staff reflective of the patients andcommunities we serve.Equal employment opportunities are provided to all employees and applicantsfor employment without regard to race, color, religion, gender,national origin, citizenship, age, disability, sexual orientation,genetic information, gender identity, protected veteran status, or anyother legally protected category in accordance to applicable federal,state, orThe policy applies to all terms and conditions of employment including, butnot limited to, hiring, placement, promotion, termination, layoff,transfer, lea