Kindred
Denials and Appeals Coordinator
Location:
Round Rock Area
Company:
ScionHealth
Job Summary The Denials & Appeals Coordinator serves as the operational driver for timely and effective denial management, working closely with other members of the team to ensure no step is missed in preventing and resolving authorization‑related denials. The role focuses on denial prevention, monitors concurrent review processes, tracks potential issues, and ensures timely follow‑up for designated facilities. The coordinator actively tracks, organizes, and reports denial activity, partnering with case management teams and other stakeholders to ensure alignment and swift resolution.
Essential Functions
Serve as a key member of the Central Access and Authorizations Team (CAAT) and subject‑matter expert on denial prevention and coordination.
Gather clinical information from medical records, including printing and scanning into required systems.
Ensure all denial‑related documentation is complete, accurate, and submitted within required timeframes.
Collaborate with CAAT, Business Development, Case Management, and Clinical Teams in the denial management process.
Coordinate and schedule peer‑to‑peer physician consults when needed.
Monitor and track insurance denials and identify trends in the data.
Communicate authorization outcomes to appropriate personnel (hospital and Centralized Business Office).
Manage denial root cause analysis efforts, including capturing lessons learned, identifying training opportunities, and providing appropriate communication and follow‑up.
Monitor concurrent review processes for continued stay authorizations to identify potential denial risks.
Support the denials management process by compiling data for trend analysis and communicating findings to hospital and leadership.
Monitor and track total certified days for managed payers and communicate missing certifications to hospital personnel.
Identify trends and opportunities with specific facilities, payors, and staff members related to the concurrent review process and denials.
Compile and communicate reports on denial trends for continuous improvement opportunities.
Support ongoing analytics and data reporting requirements.
Maintain knowledge of government and non‑government payor practices, regulations, standards, and reimbursement.
Maintain clinical knowledge to support the utilization management team.
Participate in continuing education and professional development activities.
Develop full knowledge of CAAT admission processes and continuously improve them.
Develop full understanding of scheduling and pre‑registration routines in Meditech and other referral platforms used by CAAT.
Perform ad‑hoc duties as assigned that fall within the scope of the CAAT team.
Knowledge, Skills, and Abilities
Team player with professional image and attitude.
Excellent oral and written communication and interpersonal skills.
Strong computer skills with standard and proprietary applications.
Attention to detail in data entry.
Act in accordance with ScionHealth’s Code of Business Conduct, policies, procedures, compliance agreements, federal and state laws, and professional standards.
Professional image for patients, families, clients, coworkers, and others.
Adherence to ScionHealth policies and practices.
Fluent in written and spoken English.
Good regular attendance.
Reporting to a building; may cover more than one building depending on market alignment and structure.
Qualifications Education
High School Diploma or GED required; Associate’s or Bachelor’s Degree preferred.
Preference for healthcare‑related concentration, licensed health care provider, or equivalent experience.
Licenses and Certifications
None required.
Experience
2+ years of healthcare experience.
Experience in case management, medical records, billing, utilization review, or admissions is a plus.
Post‑acute care and long‑term acute care experience is a plus.
Seniority Level Entry level
Employment Type Full‑time
Job Function Health Care Provider
Industries Hospitals and Health Care
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Round Rock Area
Company:
ScionHealth
Job Summary The Denials & Appeals Coordinator serves as the operational driver for timely and effective denial management, working closely with other members of the team to ensure no step is missed in preventing and resolving authorization‑related denials. The role focuses on denial prevention, monitors concurrent review processes, tracks potential issues, and ensures timely follow‑up for designated facilities. The coordinator actively tracks, organizes, and reports denial activity, partnering with case management teams and other stakeholders to ensure alignment and swift resolution.
Essential Functions
Serve as a key member of the Central Access and Authorizations Team (CAAT) and subject‑matter expert on denial prevention and coordination.
Gather clinical information from medical records, including printing and scanning into required systems.
Ensure all denial‑related documentation is complete, accurate, and submitted within required timeframes.
Collaborate with CAAT, Business Development, Case Management, and Clinical Teams in the denial management process.
Coordinate and schedule peer‑to‑peer physician consults when needed.
Monitor and track insurance denials and identify trends in the data.
Communicate authorization outcomes to appropriate personnel (hospital and Centralized Business Office).
Manage denial root cause analysis efforts, including capturing lessons learned, identifying training opportunities, and providing appropriate communication and follow‑up.
Monitor concurrent review processes for continued stay authorizations to identify potential denial risks.
Support the denials management process by compiling data for trend analysis and communicating findings to hospital and leadership.
Monitor and track total certified days for managed payers and communicate missing certifications to hospital personnel.
Identify trends and opportunities with specific facilities, payors, and staff members related to the concurrent review process and denials.
Compile and communicate reports on denial trends for continuous improvement opportunities.
Support ongoing analytics and data reporting requirements.
Maintain knowledge of government and non‑government payor practices, regulations, standards, and reimbursement.
Maintain clinical knowledge to support the utilization management team.
Participate in continuing education and professional development activities.
Develop full knowledge of CAAT admission processes and continuously improve them.
Develop full understanding of scheduling and pre‑registration routines in Meditech and other referral platforms used by CAAT.
Perform ad‑hoc duties as assigned that fall within the scope of the CAAT team.
Knowledge, Skills, and Abilities
Team player with professional image and attitude.
Excellent oral and written communication and interpersonal skills.
Strong computer skills with standard and proprietary applications.
Attention to detail in data entry.
Act in accordance with ScionHealth’s Code of Business Conduct, policies, procedures, compliance agreements, federal and state laws, and professional standards.
Professional image for patients, families, clients, coworkers, and others.
Adherence to ScionHealth policies and practices.
Fluent in written and spoken English.
Good regular attendance.
Reporting to a building; may cover more than one building depending on market alignment and structure.
Qualifications Education
High School Diploma or GED required; Associate’s or Bachelor’s Degree preferred.
Preference for healthcare‑related concentration, licensed health care provider, or equivalent experience.
Licenses and Certifications
None required.
Experience
2+ years of healthcare experience.
Experience in case management, medical records, billing, utilization review, or admissions is a plus.
Post‑acute care and long‑term acute care experience is a plus.
Seniority Level Entry level
Employment Type Full‑time
Job Function Health Care Provider
Industries Hospitals and Health Care
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