Job Description
On-going contract role
Hourly rate: $25 to $30 an hour
Location: On-site in Sellersville, PA
Shift: Monday to Friday- 8:00 am to 4:30 pm
Title: Appeals/Denials Coordinator
JOB SUMMARY
Under the general direction of the Manager of Case Management, the incumbent coordinates the third party appeal process. The Appeals Coordinator is responsible for managing, maintaining and updating the Denial Management process. Manages multiple data bases and for entry, tracking, analysis and reporting. Reconcile, manage and coordinate denied and downgraded accounts with the Business Office, Case Managers, HIM, Physician Advisors and Physician Offices.
Essential Functions
• Process 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 Meditech databases in order to provide accurate reporting at various hospital committees.
• Complete data entry for all Denial and Appeal Management processes
• Maintains all correspondences and receipt acknowledgments to ensure receipt by payors.
• Coordinate the telephonic and written appeal processes with Case Management staff, Physician Advisors and Payors
• Manage the Retro Appeal process for the department ( Commerical payors, etc.)
• Assist in the build and maintenance of department databases as needed
• Prepare and analyze reports using Excel ad department software for department and committee reporting
• Work 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 departmental operations.
• Performs Case Management Technician’s functions in her absence to ensure continuity in Case Management Department.
• Communicate Denial trends to Case Management leadership
Participate in insurance and payer meetings.
Works in conjunction with insurance company to provide info/review for medical necessity denials
Additional Responsibilities (Optional)
Required for All Jobs
• Understands and makes decisions that align with the mission, values and strategic plan.
• Demonstrates the values of Compassion, Integrity, Respect, Collaboration, Leadership, Excellence and Service.
• Adheres to the = Code of Conduct Policy.
• Ensures that services are provided in accordance with state and federal regulations, organizational policies and accreditation and compliance regulations.
• Complies with all HIPAA and privacy regulations.
• Actively participates in safety initiatives and risk mitigating measures where appropriate and completes all safety related competencies and requirements. Works safely by eliminating unnecessary risks by utilizing available equipment, procedures and resources.
• Adheres with all organizational policies and procedures.
• Performs related duties as assigned.
• Performs unrelated duties based upon operational needs in an emergency.
Company Description
We’re Infinia Search.
We’re a relationship-driven search firm that proves that talent, ambition, curiosity, and an infinite work ethic creates exponential results for our clients and candidates.
https://www.infiniasearch.com/
We’re Infinia Search. \r\nWe’re a relationship-driven search firm that proves that talent, ambition, curiosity, and an infinite work ethic creates exponential results for our clients and candidates. \r\nhttps://www.infiniasearch.com/