Appeals Coordinator

Job Details

Description

Position Summary :

Responsible for reviewing third-party payment denials, reviewing chart, communicate with physician to collect pertinent information and submit appeal letter for payment. Responsible for reporting weekly, monthly and quarterly data to pertinent departments and committees (i.e QIC, Physician Chairs, CFO, CNO etc.) Works daily with case managers to follow up on front end denials.

Identifies improvement initiatives to decrease denials.

Acts as the liaison to HQS / PRO.

Communicates with third party payers regarding denials Assist with utilization review duties.

Experience :

2 years Utilization Review in acute care hospital required. Basic information on DRGs and contract information.

Primary care nursing experience in an acute care hospital setting within a period of no less than 5 years.

Education :

Current NJ RN license. BSN or MSN strongly recommended.

Other Required License / Credentials / Skills :

Excellent interpersonal skills.

Excellent clinical nursing skills.

Working familiarity with personal computer.

Experience with database software preferred.

Bi-Weekly Hours : 80

The minimum starting rate for this position is $40.67

When determining a team members base rate, several factors may be considered as applicable (e.g., years of recent relevant experience, education, credentials, and internal equity).

At Deborah, healthcare is still about caring...for patients and team members. That is why we offer an outstanding benefits package, which includes healthcare coverage for team members in regularly budgeted positions of at least 30 hours per week. The benefits package also includes generous paid time-off, 401K matching contribution, tuition assistance, short and long term disability benefits, life insurance, meal discount, dependent care subsidy, adoption assistance and free parking.

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Equal Opportunity Employer

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