Appeals Coordinator

Temple Health; Philadelphia (Philadelphia County); On-site; USD 65,000 - 95,000; Full time

Job summary

Temple University Health System, Inc. is seeking an Appeals Coordinator responsible for clinically assessing all adverse determinations made by insurers through the entire appeals process. The role requires nursing licensure and familiarity with medical criteria.

You will assess determinations across levels, apply InterQual and Milliman criteria, and work with ICD-10-CM coding. A PA RN license and multi-state compact eligibility are required; APC coding knowledge is a plus.

Qualifications

• Graduate of an accredited nursing program.
• PA RN license required.
• Experience with InterQual and Milliman criteria.
• Experience with ICD-10-CM coding.
• General knowledge of APC coding preferred.

Responsibilities

• Assess adverse determinations across all levels of the appeals process.

Skills

InterQual criteria

Milliman criteria

ICD-10-CM coding

APC coding knowledge

Education

RN license (PA)

Multistate Compact RN license

Nursing degree

Job description

Overview

Appeals Coordinator role responsible for clinically assessing all adverse determinations made by insurers through all levels of the appeals process.

Responsibilities

• Assess adverse determinations by insurers across all levels of the appeals process.

Qualifications

• Graduate of an accredited school of nursing; PA Registered Nurse License required.
• Experience with InterQual and Milliman criteria required.
• Experience with ICD-10-CM coding required.
• General knowledge of APC coding preferred.

Licenses

• PA Registered Nurse License required.
• Multi-State Compact RN License required.

Equal Opportunity Employer/Veterans/Disabled. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.