RN Clinical Appeals Coordinator

Responsibilities

• Perform audits on all assigned clinical denials.
• Construct necessary appeals with payers for reconsideration of denied charges and services.
• Identify the root cause of denials and provide education to Care Managers, Providers, and Charge Departments.
• Act as a clinical resource to Patient Financial Services and other departments regarding payment, charge, or clinical inquiries.
• Take responsibility for individual performance goals and other assigned duties.

Requirements

• Bachelor's degree in Nursing from an accredited program.
• Minimum of five years of experience in utilization review and/or auditing in an acute-care hospital setting.
• Proficiency in applying Milliman and/or Interqual guidelines.
• Strong knowledge of medical coding, reimbursement, and insurance practices.
• Solid understanding of Medicare levels of care (inpatient/observation).
• Proficiency in MS Word and Excel.
• Excellent interpersonal, communication, and presentation skills.
• Ability to use independent judgment to compose persuasive appeals using clinical data and regulatory guidelines.

About the Company

Concord Hospital is a nationally-accredited, progressive regional health system. Evolving from a community hospital into a $550 million net revenue integrated health system, we are a community-centered organization with over 3,500 talented employees. We are recognized for our sophisticated clinical practices and were the first healthcare system in New Hampshire to achieve ISO 9001:2008 certification for quality management processes.