Denial Operations Coordinator

$42,078 - $78,125/Yr

Nuvance Health - Danbury, CT

Full-time - Entry Level

Danbury, CT

Nursing and Residential Care Facilities

About the position

The Denial Operations Coordinator at Nuvance Health plays a crucial role in managing clinical denials effectively and efficiently. This position requires close collaboration with various stakeholders, including physical advisors, Clinical Denial Specialist nurses, case managers, and insurance companies. The coordinator is responsible for identifying and communicating clinical denials promptly, ensuring that appeals are sent to insurance companies, including Medicare and Medicaid, for the entire network. This role also involves providing administrative and clerical support to enhance the operational efficiency of the department. In this position, the coordinator will review new and appeal upheld cases in the work queue and incoming fax queue, as well as denial letters received through daily mail. They will identify retro denials and document them appropriately, notifying nurses of new retro denials in a timely manner. The coordinator will create weekly assignments for the director to review for appeals and communicate with insurance companies to schedule peer-to-peer reviews, following up on the outcomes. Additionally, they will send appeals with the necessary documentation to payors within the required timeframes and maintain accurate records in the denial tracking tool. The role requires strong organizational skills, the ability to analyze data, and effective communication with team members, other departments, and insurance companies. The coordinator must demonstrate flexibility and composure in stressful situations while fulfilling compliance responsibilities related to the position. Regular attendance and adherence to Nuvance Health values are also essential components of this role.

Responsibilities

• Reviews new and appeal upheld cases in work queue and incoming fax queue.
• Reviews denial letters through daily mail.
• Identifies retro denials and documents appropriately.
• Notifies new retro denials to nurses in a timely manner.
• Creates a weekly assignment for director to review for appeals.
• Communicates with insurance companies to schedule a peer-to-peer review and follow up on the outcomes.
• Sends the appeals with appropriate documents to the payors within the payors' timeframe.
• Documents and updates the denials in the denial tracking tool timely and accurately.
• Collects and analyzes the data as requested.
• Interacts professionally with team members within the department, other departments, and insurance companies.
• Demonstrates the ability to be flexible and organized during stressful situations.
• Fulfills all compliance responsibilities related to the position.
• Maintains and models Nuvance Health values.
• Demonstrates regular, reliable, and predictable attendance.
• Performs other duties as required.

Requirements

• High School Diploma or GED required.
• Excellent interpersonal skills.
• Strong organizational skills.
• Effective time management skills.
• Experience with Windows-based computer systems, including MS Office (Word, Excel, MS Teams).
• Good communication skills.

Nice-to-haves

• Bachelor's degree preferred.
• Previous hospital or other healthcare setting experience preferred.