Responsibilities

Under the general direction of the Director of Case Management, the Appeals Coordinator manages the third-party appeal process and is responsible for managing, maintaining and updating the Denial Management process. The Appeals Coordinator manages multiple databases for entry, tracking, analysis and reporting. The Appeals Coordinator reconciles, manages and coordinates denied and downgraded accounts with the Business Office, Case Managers, HIM, Physician Advisors and Physician Offices.

Essential Functions:

• Processes third-party denials/appeals upon notification of an insurance denial, either by the Case Manager or the insurance company.
• Manages third-party appeals and denials in the Case Management and electronic medical record (EMR) databases in order to provide accurate reporting at various hospital committees.
• Completes data entry for all Denial and Appeal Management processes.
• Maintains all correspondences and receipt acknowledgments to ensure receipt by payors.
• Coordinates the telephonic and written appeal processes with Case Management staff, physician advisors and payors.
• Manages the Retro Appeal process for the department (RAC, MAC, QIC, commerical payors, etc.).
• Assists in the build and maintenance of department databases as needed.
• Prepares and analyzes reports using Excel and department software for department and committee reporting.
• Works with Business Office to investigate and resolve outstanding utilization review/reimbursement issues.
• Participates as a team member in establishing procedures relating to Case Management functions to promote efficient operations.
• Demonstrates ability to prioritize work assignments in order to meet deadlines and maintain timely department operations.
• Performs Case Management Technician’s functions in her absence to ensure continuity in Case Management Department.
• Communicates denial trends to Case Management leadership.

Qualifications

EDUCATION AND EXPERIENCE:

• High school diploma/GED required and 1-3 of years business experience in education or healthcare-related required.
• Prefer knowledge of billing, case management coding, precertification, contracts, financial account reconciliation and insurance payor regulations (commercial and government).

BENEFITS:

We offer a competitive salary and comprehensive benefits to part-time and full-time employees, including:

• Medical, dental and vision insurance available the first of the month after start date
• Wellness and gym discounts and free cardiac rehab gym
• 403b
• On-site discounted child care center
• Paid time off
• Sick time for full-time employees
• Tuition assistance
• Free life insurance for full-time employees
• Long-term disability for full-time employees
• Short-term disability
• Employee referral bonus
• Identity theft insurance
• Pet insurance
• Flexible spending accounts
• Employee discount program
• Employee assistance program
• Free parking