Grand View Hospital
Appeals Coordinator
Grand View Hospital, Sellersville, Pennsylvania, United States, 18960
Responsibilities:
Under the general direction of the Director of Case Management, the Appeals Coordinator manages the third party appeal process. The Appeals Coordinator is responsible for managing, maintaining and updating the Denial Management process. The Appeals Coordinator manages multiple data bases and 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 correspondence and receipt acknowledgments to ensure receipt by payors.Coordinates the telephonic and written appeal processes with Case Management staff, Physician Advisors and Payors.Manage the Retro Appeal process for the department (RAC, MAC, QIC, Commercial payors, etc.)Assists in the build and maintenance of department databases as needed.Prepares and analyzes reports using Excel ad 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 departmental operations.Performs Case Management Technicians 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, requiredOver 1 year to 3 years business education or health care related experience, requiredKnowledge of Billing, Case Management Coding, Pre-certification, contracts, financial account reconciliation and insurance Payor regulations (Commercial and Government), preferred
Benefits:We offer a competitive salary and comprehensive benefits to part-time and full-time employees including:Medical, dental, & vision insurance available 1st of the month after start dateWellness and gym discounts & free cardiac rehab gym403BOn-site discounted childcare centerPaid time offSick time for full time employeesTuition assistanceFree life insurance for full time employeesLong term disability for full time employeesShort term disabilityEmployee referral bonusIdentity theft insurancePet InsuranceFlexible spending accountsEmployee discount programEmployee Assistance ProgramFree parking
Under the general direction of the Director of Case Management, the Appeals Coordinator manages the third party appeal process. The Appeals Coordinator is responsible for managing, maintaining and updating the Denial Management process. The Appeals Coordinator manages multiple data bases and 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 correspondence and receipt acknowledgments to ensure receipt by payors.Coordinates the telephonic and written appeal processes with Case Management staff, Physician Advisors and Payors.Manage the Retro Appeal process for the department (RAC, MAC, QIC, Commercial payors, etc.)Assists in the build and maintenance of department databases as needed.Prepares and analyzes reports using Excel ad 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 departmental operations.Performs Case Management Technicians 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, requiredOver 1 year to 3 years business education or health care related experience, requiredKnowledge of Billing, Case Management Coding, Pre-certification, contracts, financial account reconciliation and insurance Payor regulations (Commercial and Government), preferred
Benefits:We offer a competitive salary and comprehensive benefits to part-time and full-time employees including:Medical, dental, & vision insurance available 1st of the month after start dateWellness and gym discounts & free cardiac rehab gym403BOn-site discounted childcare centerPaid time offSick time for full time employeesTuition assistanceFree life insurance for full time employeesLong term disability for full time employeesShort term disabilityEmployee referral bonusIdentity theft insurancePet InsuranceFlexible spending accountsEmployee discount programEmployee Assistance ProgramFree parking