Denials and Appeals Coord RN (Full-Time/Day)

Thomas Jefferson University & Jefferson Health
Published
May 12, 2022
Location
Philadelphia, PA
Category
Job Type

Description

Responsibilities

The Denials and Appeals Coordinator facilitates, investigates and reports on the appeal processes for hospital claims denied by any payer, including Medicare for medical necessity. Examines trends in status and denials activities to promote performance improvement. Facilitates all medical necessity appeal activities.

  • Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
  • Coordinates responsibilities and activities with Utilization Management and Case Management personnel
  • Performs reviews on denial accounts to validate root causes by department and/or payer
  • Assist with preparing and coordinating follow-up activities to resolve organization deficiencies with regards to denials
  • Maintains knowledge of payer contracts and billing requirements
  • Completes work within deadlines; identifies opportunities for improvement and problem resolution
  • Collaborates with members of the healthcare team and providers in a positive, professional, progressive and assertive manner

Qualifications

Minimum Education and Experience Requirements:

Education:

Bachelors Nursing required

AND

Experience:

Minimum of 5 years' experience in utilization management required

Excellent oral and written communication and negotiation skills. Strong organizational, time management, and problem-solving skills. Ability to work independently and exercise sound judgment and interactions with patients, families, physicians, and payers. Advanced computer skills required. Knowledge of discharge planning, utilization management, case management, and managed care reimbursement required. Ability to be flexible, open-minded, and adaptable to change.

Minimum Certifications, Registration or License Requirements:

Registered Nurse, Pennsylvania/New Jersey. Certification in InterQual criteria preferred.

Conditions of Employment

Since this position will require the selected candidate to engage in regular contact with children in the form of care, guidance, supervision or training, you will be required to meet the requirements of the Child Protective Services Act, including the Pennsylvania State Police criminal background check, the Pennsylvania Department of Welfare child abuse criminal background clearance, and an FBI finger print based federal criminal records check. The selected candidate will not be allowed to commence working until all three (3) are completed satisfactorily.

Closing Statement

Jefferson includes Thomas Jefferson University and Jefferson Health, a dynamic university and health system with broad reach across the Delaware Valley. Jefferson is the second largest employer in Philadelphia and the largest health system in Philadelphia based on total licensed beds.

Through the merger of Thomas Jefferson University and Philadelphia University in 2017, our University includes ten colleges and four schools. We are an NCAA Division II university and an R2 national doctoral university offering undergraduate and graduate-level programs that provide students with a forward-thinking education in architecture, business, design, engineering, fashion and textiles, health, medicine and social science.

Jefferson Health, the clinical arm of Thomas Jefferson University, has grown from a three-hospital academic health center in 2015, to an 18-hospital health system through mergers and combinations that include hospitals at Abington Health, Aria Health, Kennedy Health, Magee Rehabilitation and Einstein Healthcare Network. We have over 50 outpatient and urgent care centers; ten Magnet®-designated hospitals (recognized by the ANCC for nursing excellence); the NCI-designated Sidney Kimmel Cancer Center (one of only 70 in the country and one of only two in the region); and one of the largest faculty-based telehealth networks in the country. In 2021, Jefferson Health became the sole owner of HealthPartners Plan, a not-for-profit health maintenance organization in Southeastern Pennsylvania. We are the first health system regionally to create an aligned payer-provider partnership.

Jefferson's mission, vision and values create an organization that attracts the best and the brightest students, faculty, staff, and healthcare professionals, as well as the most visionary leaders to drive exceptional results.

  • OUR MISSION: We improve lives.
  • OUR VISION: Reimagining health, education and discovery to create unparalleled value
  • OUR VALUES: Put People First, Be Bold & Think Differently and Do the Right Thing

As an employer, Jefferson maintains a commitment to provide equal access to employment. Jefferson values diversity and encourages applications from women, members of minority groups, LGBTQ individuals, disabled individuals, and veterans.

Par Reference Code

49389

Apply
Drop files here browse files ...

Related Jobs

Lead Preschool Teacher   Philadelphia, PA new
May 26, 2022
Language teacher - Portuguese   Philadelphia, PA new
May 26, 2022
Customer Service Representative   Norristown, PA new
May 26, 2022
Customer Service Representative   Philadelphia, PA new
May 26, 2022
May 26, 2022

Author: