Utilization Review.Denials and Appeals Process Coordinator (Adminstrative Coordinator) - (Part Time, Day Shift)

📁
Revenue Cycle
💼
Cottage Health
📅
2000002A Requisition #
The Utilization Review and Denials and Appeals Process Coordinator is responsible for all clerical aspects of denials and appeals including, but not limited to, processing requests for concurrent or retro reviews. This individual will be a liaison and point of contact to/for PBS, UM and other Cottage Health representatives for denial and appeal inquiries. This individual must be able to work independently and manage customer service and project workflow.

MAJOR ACCOUNTABILITIES

Sort, analyze and appeal denied non-clinical claims and/or underpayments from assigned Revenue Integrity work queues, perform follow up calls to the payer based on departmental standards/policy, report denial trends and observations at departmental meetings. Write clear and professional appeals to our payors using payor specific forms and templates.

Assist in managing, analysis, and performing denials and appeals reporting in Epic and through reporting software, including processing, training, and maintenance, as required. Use analytical and reporting tools to identify trends and patterns of denied claims. Collaborate with leadership and the root cause departments to review the data and create process improvements to help eliminate preventable denials.

Sort clinical review requests and/or denials from payors. Scan hard copy to medical records. Provide support to the UR nurses if needed.

Assist in inventory management of denials and appeals vendor. 

QUALIFICATIONS

TECHNICAL REQUIREMENTS 

Minimum: Intermediate MS Excel, Word, Outlook, and PowerPoint skill and proficient Internet skills 

Preferred: Proficiency with electronic medical records, databases, and clinical application software 

YEARS OF RELATED WORK EXPERIENCE 

Minimum: 2 years of clerical experience in a healthcare setting 

Preferred: Previous experience in denials and appeals, insurance follow up, and patient financial services

 

  


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