1+ months

311101 Clin Appeals Coordin

Penn Medicine
Philadelphia, PA 19104
The Case Management department at Penn Presbyterian Medical Centerhas a Clinical Appeals Coordinator opportunity available.Responsibilities for this position include but are not limited to the following:Playing an essential role in maximizing collection of revenue for patient casesProviding oversight to the process and assisting Case Managers' at PPMC in this important departmental processOverseeing the appeals and denial process from beginning to endWorking closely with the Director, Physician Advisors and Clinical Resources Management's Team Leads to ensure billing of appropriate level of care for all patients in the hospital.AccountabilitiesReviewing denied days to identify opportunities for appealWorking closely with CM's and Physician Adviser to identify those cases with maximum appeal potentialComposing appeal letters utilizing IS and SI criteria, reviewing medical records and EPIC documentation to defend appealsCollaborating with physiciasn to support appeal of casesReviewing denial letters daily. Assuring EPIC denial accurately reflects third party payer lettersCollaborating with Physician Adviser in denial activity reviewPreparing and participating in presentations to Facilitating communication between Finance, Business Office, and Quality improvement office for monthly and quarterly reportsAssuring reports are timely and accurate.¢\tInteracts with Patient Accounting to assure maximum revenue enhancement.¢\tDevelops, implements, reports monthly denials and appeal activity while assuring deadlines for reporting are met.¢\tAnalyze denial trends by service, payer, and physician. Produce reports as required related to third party payer activity.¢\tFunction as CM in times of personnel shortages.¢\tCoordinator is responsible for management of lists and processes related to denials and appeals.¢\tCoordinator also prepares quarterly denial reports by service as requested. Coordinator participates in Medicare and Medicaid chart reviews for medical necessity. ¢\tPerforms duties in accordance with Penn Medicine and entity values, policies, and procedures¢\tOther duties as assigned to support the unit, department, entity, and health system organization

Please apply if you possess these qualifications:\nBachelors degree in nursing required\n5+ years RN Case Manager and /or Appeals Coordinator experience required\nAn active PA State RN Licensed in Good Standing required\nSkills and Abilities needed:\nAbility to use Microsoft Office (Excel, Outlook, Word)\nEffective communication skills in various methods, verbal, written, and presentations\nAbility to multi-task\nA proactive innovator and problem solver regarding the healthcare economics facing health systems today\nDemonstrated collaboration with peers

Categories

Posted: 2021-08-03 Expires: 2021-10-01

Share this job:

311101 Clin Appeals Coordin

Penn Medicine
Philadelphia, PA 19104

Join us to start saving your Favorite Jobs!

Sign In Create Account
Powered ByCareerCast