Nuvance Health - Danbury, CT
posted 3 months ago
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.