Denial and Appeals Coordinator Full Time

About the role

The Denial and Appeals Coordinator serves as the operational driver for timely and effective denial management, working closely with other members of the team, especially utilization management, to ensure no step is missed in preventing and resolving authorization-related denials. While not a clinical role, this position is critical in executing the processes that protect revenue and keep patient care moving forward.

Responsibilities

• Serves as key team member of the new Central Access and Authorizations Team (CAAT), serving as a subject matter expert on denial prevention and coordination.
• Works with facility to gather clinical information from medical record. Responsibility may include printing and scanning into required systems.
• Ensures all denial-related documentation is complete, accurate, and submitted within required timeframes.
• Collaborates with other members of the CAAT, Business Development, Case Management, and Clinical Teams in denial management process.
• Captures lessons learned, identifies training opportunities, and provides appropriate communication and follow up to the teams.
• Maintains working knowledge of government and non-government payor practices, regulations, standards and reimbursement.
• Maintains clinical knowledge to support the utilization management team.
• Participates in continuing education/ professional development activities.
• Learns and develops full knowledge of the CAAT Admission Processes and actively seeks to continuously improve them.
• Learns and has a full understanding of scheduling and pre-register routines in Meditech and any other referral platform utilized by the CAAT team (i.e., Referral Manager).

Requirements

• High School Diploma or GED required, Associates or Bachelors Degree preferred;
• Preference towards a healthcare related area of concentration or be a licensed health care provider or equivalent experience.
• 2+ years of healthcare experience.
• Experience in case management, medical records, billing, utilization review or admissions a plus.
• Post-acute care and long-term acute care experience a plus.

Skills

• Team player, able to communicate and demonstrate a professional image/attitude
• Excellent oral and written communication and interpersonal skills
• Strong computer skills with both standard and proprietary applications
• Data entry with attention to detail

Benefits

Includes benefits such as career development, healthcare, retirement plan, paid time off, work-life balance, miscellaneous benefits, and more.

Pay

N/A

Schedule

N/A