Job Description
Day to Day:
Insight Global is looking for a Denial Coordinator to support a large hospital system in the Maryland/DC area. This person will be overseeing and managing the insurance denial and appeals process to minimize financial risk and improve reimbursement outcomes.
Primary Responsibilities:
• Coordinate and monitor denial management and appeal processes, leveraging clinical, business, and regulatory acumen to reduce financial exposure.
• Evaluate all external denials related to medical necessity and assess the feasibility of submitting appeals.
• Draft medical summaries of denied cases for review by hospital leadership and for escalation to legal or regulatory bodies (e.g., Maryland Insurance Administration) when necessary.
• Identify root causes and trends in denials and create strategies to prevent future occurrences and enhance care delivery efficiency.
• Maintain tracking records for both concurrent and retrospective denial activity in collaboration with case management and patient financial services teams.
• Provide data and case reporting to leadership and relevant committees (e.g., Operations Review Committee)
• Work closely with physicians, utilization review RNs, case managers, revenue cycle staff, and payers during the appeals process
• Serve as a resource for staff, educating teams on denials and utilization review best practices; support orientation for new staff.
• Participate in departmental and community meetings or committees as needed.
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.
Required Skills & Experience
• High school diploma or equivalent
• 3+ years’ experience working in denials (following up on appeals, making adjustments, etc.)
• Experience with prior authorization and insurance follow-up
• Experience with writing appeal letters
o Not just filling out form letters, someone who can put a case together
• Experience utilizing payor portals (EVS, Availity, etc.)
• Tech Savvy (Excel, Teams, etc.)
• Detail-oriented
• Comfortable training virtually
Nice to Have Skills & Experience
• Hospital billing experience
• Experience with systems: Med-Connect for medical records, RCI (repository where denials go), Envision (SMS), Epic
• Experience with MD reimbursements
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.