Job Description
High Dollar Denials Coordinator
Full-Time | Monday–Friday | Flexible start time between 7:00 AM–9:00 AM
Our team is hiring a Medical High-Dollar Denials & Claims Coordinator to support a growing Clinical Documentation Improvement (CDI) unit within a major healthcare system. This role is ideal for a critical thinker with strong insurance knowledge and experience managing complex, high-dollar outpatient claims. The ideal candidate will have extensive experience with Maryland/DC payers.
Key Responsibilities:
- Review, monitor, and resolve denials and write-offs related to outpatient claims
- Create and maintain Excel reports to track reimbursement trends and payer issues
- Identify non-payment patterns, escalate trends, and collaborate with outpatient departments
- Submit authorizations, referrals, and appeal requests to support reimbursement efforts
- Partner closely with Financial Counselors, Managed Care teams, and PFS departments
- Prevent scheduling of elective self-pay procedures (cosmetic or sterilization) without pre-payment
- Attend payer update seminars and provide internal updates on insurance policy changes
Qualifications:
- 3–4 years of experience in a healthcare setting with strong insurance knowledge
- Familiarity with Maryland/DC payers including UH, Kaiser, and MedStar Family Choice
- Working knowledge of UB04s, EOBs, CPT/ICD-10 coding, and insurance portals (e.g., HDX, iExchange)
- Strong Excel skills required
- CHAA or CRCS-I certification preferred
Work Environment:
- The ideal employee would be within driving distance of the office in White Marsh, MD; however, the employee does not have to be.
Job Tags
Full time, Flexible hours, Monday to Friday,