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RN Appeals Coordinator Job

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Date: Oct 13, 2021

Location: Memphis, TN, US

Company: Methodist Le Bonheur Healthcare

Summary

Responsible for coordinating and monitoring the denials management and appeals process. Serves as a liaison between patient financial services and Case Management, monitoring and reporting identified certification and payer issues. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

Education/Experience/Licensure

 

Education/Formal Training

Work Experience

Credential/Licensure

 

REQUIRED:

Graduate of an accredited school of Nursing

 

5 years clinical experience.

 

Experience in Case Management, Care Coordination, Care Facilitation or discharge planning required.

 

RN with current license to practice to practice as a professional nurse in the state of employment.

 

 

 

PREFERRED:

BSN preferred.

 

 

Experience in Denials Management preferred.

 

Experience with Care Management/Utilization Management software packages preferred.

 

Certified Case Manager preferred.

 

 

SUBSTITUTIONS ALLOWED:

N/A

N/A

N/A

Knowledge/Skills/Abilities

  • Positive working relationship and excellent interpersonal skills in working with physicians required.
  • Excellent written and verbal communication skills.
  • Ability to plan and schedule tasks and to maintain control of own work flow.
  • General PC skills.
  • Ability to communicate information to groups of people in an educational setting.
  • Effective interpersonal relationship skills.

Key Job Responsibilities

  • Manages and appeals denials.  Coordinates appeal efforts.
  • Identifies, monitors and reports problematic areas in the certification process, which may impact registration, billing, and reimbursement.
  • Actively participates in Methodist CIP efforts; identifies and communicates areas for improvement in ongoing efforts for quality care; assists in gathering, analyzing, and presenting data in the assigned populations.
  • Demonstrates initiative in identifying and pursuing opportunities for self-improvement and enhancement of professional competency.
  • Demonstrates effective customer relation skills, promotes a positive work environment, and contributes to the overall team effort. Establishes a good working relationship with physicians, clients, and other members of the health care team.
  • Understands, applies, and supports department/hospital policies, procedures, and standards.
  • Performs other job functions as requested or assigned.

Physical Requirements

  • Non-invasive patient contact.
  • Must be able to read, write, and communicate both orally and in writing to individuals in the healthcare field.
  • Normal or corrected-to-normal vision.
  • Must have good balance and coordination.


Nearest Major Market: Memphis

Job Segment: Nursing, Registered Nurse, Healthcare