Coordinator, Denial Management Professional Billing (On Site, Hybrid)

At Northbay Health, the Coordinator, Denial Management is responsible for the monitoring, analytics, reporting, and coordination of professional fee healthcare claims denials and underpayments. The incumbent works with the PFS division, practice operations, providers, and other facility staff to create reports, monitor trends, and provide feedback, training, and corrective oversight related to billing, coding, and contractual reimbursement issues identified through claim denials, edits, and underpayments. The purpose of this role is to ensure appropriate reimbursement in accordance with payer contracts and applicable government fee schedules.

Primary Job Responsibilities

• Create, review, and analyze payer underpayment and variance reports; distribute findings weekly and recommend corrective actions.
• Utilize EHR, billing systems, payer portals, and Microsoft Office tools effectively.
• Research and evaluate denial and underpayment trends; propose process improvements.
• Plan, organize, and prioritize workload to manage high volumes of data accurately and efficiently.
• Participate in meetings, training sessions, and team development activities.
• Maintain current knowledge of eligibility requirements, payer guidelines, government regulations, and industry standards.
• Demonstrate a comprehensive understanding of billing procedures, HIPAA 837P/835 transactions, CMS-1500, UB-04, CARC/RARC codes, and common claim edits.
• Provide training to the PFS team based on data analysis and identified trends.
• Collaborate with other departments to resolve denials and improve reimbursement processes.
• Perform other duties as assigned.

Education

• Associate’s degree preferred, or an equivalent combination of education and/or at least 3 years of related experience.

Licensure/Certification

• All new hires will be required to complete the HFMA Certified Revenue Cycle Representative (CRCR) training course within the first nine (9) months of employment.
• Membership, training, and certification costs will be sponsored by the employer.

Experience

• 5 years of experience in professional billing, with in-depth knowledge of CPT, ICD, and HCPCS coding.
• Understanding of payer contracts, payment structures, and federal/state regulations.
• Proficiency with compliance laws and collection laws.

Skills

• Excellent oral and written communication skills.
• Proficiency in PC applications and Microsoft Office Suite, especially Excel.
• Strong analytical skills with attention to detail.
• Skilled in training and providing education to staff.
• Strong organizational skills.

Interpersonal Skills

• Ability to prioritize tasks and communicate delays effectively.
• Communicate clearly across all organizational levels.
• Collaborate effectively with team members for professional communication and inclusion.

Standards of Performance

• Demonstrate performance by adhering to established policies and procedures and exhibiting the defined characteristics associated with attendance and punctuality.

Physical Effort

• Attendance is an essential function of the job.
• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.