Leads, coordinates, and monitors denial and audit activities for Ephraim McDowell Health. Provides oversight of third-party auditing functions, tracks activity status across systems, and prepares administrative reports. Supports appeals, medical necessity audits, DRG denial review, and coordination with coding, CDI staff, and physician advisors.
Key responsibilities
- Monitor denial and audit activity across departments and systems
- Identify targeted audit topics and educate affected areas on documentation and payment requirements
- Review and apply state and federal denial reports
- Maintain denial records and report denial trends
- Meet appeal deadlines and prepare medical record requests for medical necessity audits
- Review experimental/investigational denials and support education efforts
- Participate in denial committee activities
- Work with coding and CDI staff to ensure complete, accurate DRG appeal letters
- Coordinate with physician advisors on appeal letters for insurance companies regarding DRG and clinical denials
- Report DRG denial amounts and trends monthly
- Coordinate audits with third-party companies requesting medical record access or onsite review
- Maintain confidentiality, professional accountability, and positive interdepartmental relationships
- Contribute to efficient department and organizational operations
Requirements & Qualifications
Requirements
- None required
- Proficiency in computer skills, including word processing and spreadsheet use
- Ability to communicate effectively with department directors, office managers, consultants, and outside auditors
- Ability to work in a typical office setting and spend moderate time at a computer terminal
- Ability to move or position up to 25 lbs
- Commitment to ethical coding standards and official coding guidelines
Location
Kentucky, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 month ago