Clinical Appeals Coordinator - Concord Hospital - Part Time

About the role

The Clinical Appeals Coordinator is responsible for supporting Concord Hospital with claim appeal activities within the Revenue Integrity department. This involves a timely and accurate review of medical records in response to claim denials received from third party payers, Recovery Audit Contractors (RAC), Medicare Administrative Contractors (MAC), as well as medical necessity denials from other governmental and non-governmental payers and auditors. The Clinical Appeals Coordinator will evaluate opportunities for education and provide feedback to physicians the RCC Committee, and other relevant departments. Additionally, this person will serve as a clinical resource to the entire Revenue Management division. Education Bachelor's degree in Nursing from an accredited Nursing program. Certification, Registration & Licensure

Responsibilities

• Performs audits on all assigned clinical denials.
• Constructs all necessary appeals with payers for reconsideration of denied charges and/or services.
• Identifies root cause of denials and provides education to Care Managers, Providers and Charge Departments as appropriate.
• Acts as a clinical resource to Patient Financial Services and other Concord Hospital departments for payment/charge issues and other clinical inquiries that may or may not be related to audits and appeals.
• Takes responsibility for individual performance goals.
• Performs other duties as assigned.
• Know Your Rights: Workplace Discrimination is Illegal
• Applicants to and employees of this company are protected under federal law from discrimination on several bases. Follow the link above to find out more.
• If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, you may contact Human Resources at 603-230-7269.

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