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.

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