Denial & Appeals Coordinator- Onsite, Green Cove Springs, FL

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.

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.
• 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 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).
• Supports ongoing analytics and data reporting requirements.

Knowledge/Skills/Abilities/Expectations

• 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.
• Communicates and demonstrates a professional image/attitude for patients, families, clients, coworkers and other.
• Adheres to policies and practices of ScionHealth.
• Must read, write, and speak fluent English.
• Must have good and regular attendance.
• Will report to a building; may cover more than one building depending on market alignment and structure.
• Approximate percent of time required to travel: N/A.

Qualifications

• 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.