Denial and Appeals Coordinator Full Time San Gabriel Area

Description

At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.

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, 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.

Essential Functions

• 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.
• Coordinates and schedules peer to peer physician consults as needed; may work with case management if attending physician is completing peer to peer, or may work directly with physician advisory group to schedule.
• 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 continously 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).
• And ad hoc duties as assigned that fall within scope of the CAAT team.

Qualifications

• Education: 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.
• Licenses/Certifications: None Required.
• 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.