Clinical Appeals Coordinator-Pt

Hello,

Thank you for your interest in career opportunities with the University of Mississippi Medical Center. Please review the following instructions prior to submitting your job application:

• Provide all of your employment history, education, and licenses/certifications/registrations. You will be unable to modify your application after you have submitted it.

• You must meet all of the job requirements at the time of submitting the application.

• You can only apply one time to a job requisition.

• Once you start the application process you cannot save your work. Please ensure you have all required attachment(s) available to complete your application before you begin the process.

• Applications must be submitted prior to the close of the recruitment. Once recruitment has closed, applications will no longer be accepted.

After you apply, we will review your qualifications and contact you if your application is among the most highly qualified. Due to the large volume of applications, we are unable to individually respond to all applicants. You may check the status of your application via your Candidate Profile.

Thank you,

Human Resources

Important Applications Instructions:

Please complete this application in entirety by providing all of your work experience, education and certifications/

license. You will be unable to edit/add/change your application once it is submitted.

Job Requisition ID:

R00036063

Job Category:

Nursing

Organization:

Rev Cycle - Payor Contract Management

Location/s:

Central Billing Office-Clinton

Job Title:

Clinical Appeals Coordinator-PT

Job Summary:

To provide coordination and support of university hospitals and health system /university physician billing process and the denials and appeals review process. To participate in the review, evaluation, monitoring, measuring and adjustment of all patient care payments denials and associated claims; participates in the development of risk minimization appeals program. Conducts research including departmental interviews/communication for verification of denial, clinical review of the denial, and conducts a reporting process for quality improvement initiatives to prevent future issues.

Education & Experience

Associates degree in nursing (ADN) plus five (5) years of clinical nursing experience or a Bachelors in a Nursing plus three (3) years of clinical nursing experience. Utilization review and/or case management is preferred.

Certifications, Licenses or Registration Required:

Valid RN license.

Knowledge, Skills & Abilities

Knowledge and understanding of clinical organization structure, workflow, and operating procedures. Skill in the use of personal computers and related software applications. Ability to manage multiple priorities under time constraints; ability to analyze and solve problems. Understanding cost and quality issues. Verbal and written communication skills. Interpersonal skills to interact with a wide range of constituencies. Decision-making skills.

Responsibilities

• Reviews patient medical records and collects data for billing and/or appeals process management, analysis, studies, and monitoring. Communicates with insurer to determine if payments/denials are appropriate.

• Collect, review and perform timely appeals on medical necessity denials and/or authorization denials.

• Conducts clinical research and analyses and prepares reports as required; anticipates and identifies issues in order to develop strategies and solutions in the payment and appeals process. Assist as needed with chart audits, reviewing and comparing the medical records against the patient's itemized bill to ensure complete and accurate revenue integrity.

• Participates in planning system-wide measurement initiatives with respect to assessment and management of accounts to determine patterns and trends of payment and/or denials and facilitates communication to improve performance and educate management.

• Assists in the review of clinical practice for quality improvement and loss control; recommends appropriate corrective action; reviews for consistency, adherence to policy and comparative level of care in all settings; inputs data and prepares reports. Communicates with clinical and non-clinical staff all findings. Communicates and negotiates with external stakeholders.

• Maintains an understanding of current TJC standards pertaining to denial and appeals management; assists the university hospitals and health system to maintain compliance with regulatory standards, federal and local as it pertains to denial of claims.

• Provides timely internal/external customer service in a cooperative, professional, and respectful manner.

• The duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.

Physical and Environmental Demands

Requires occasional exposure to unpleasant or disagreeable physical environment such as high noise level and exposure to heat and cold, occasional exposure to bio-hazardous conditions such as risk of radiation exposure, blood borne pathogens, fumes or airborne particles, and/or toxic or caustic chemicals which mandate attention to safety considerations, occasional working hours significantly beyond regularly scheduled hours, occasional travelling to offsite locations, occasional work produced subject to precise measures of quantity and quality, occasional bending, occasional lifting and carrying up to 25 pounds, occasional crouching/stooping, occasional kneeling, occasional pushing/pulling, frequent reaching, frequent sitting, frequent standing, occasional twisting, and frequent walking. (occasional-up to 20%, frequent-from 21% to 50%, constant-51% or more)

Time Type:

Part time

FLSA Designation/Job Exempt:

No

Pay Class:

Hourly

FTE %:

56.25

Work Shift:

Benefits Eligibility:

Grant Funded:

Job Posting Date:

04/15/2024

Job Closing Date (open until filled if no date specified):