Denials Management Appeals Coordinator - Revenue Integrity/CDM

McLeod Health; Florence (SC); On-site; USD 45,000 - 70,000; Full time

Job summary

An established industry player is seeking a Denials Management Appeals Coordinator to join their dynamic team. This role involves reviewing patient medical records, determining appeal requirements, and collaborating with various departments to address claim denials. The ideal candidate will have a strong background in managed care terminology and healthcare appeals, along with excellent interpersonal and organizational skills. Join a dedicated team that values professionalism and service excellence, and make a meaningful impact in the healthcare sector.

Qualifications

• 2+ years of healthcare appeals experience preferred.
• Strong knowledge of managed care reimbursement methodologies.

Responsibilities

• Review patient medical records to determine appeal needs.
• Collaborate with departments regarding appeals and denials.

Skills

Managed Care Terminology

Healthcare Appeals Experience

Interpersonal Skills

Attention to Detail

Organizational Skills

Education

Valid RN License

Some College

Tools

Microsoft Excel

Microsoft Word

Job description

Denials Management Appeals Coordinator - Revenue Integrity/CDM

Florence, SC, United States (On-site)

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Job Description

• Maintains a professional image and exhibits excellent customer relations to patients, visitors, physicians, and co-workers in accordance with our Service Excellence Standards and Core Values.
• Responsible for any claim denials regarding medical necessity and authorization and acts as a resource to outside departments relative to the denials process.
• Review patient medical records and utilize clinical and regulatory knowledge and skills as well as knowledge of payer requirements to determine why cases are denied and whether an appeal is required.
• Search for supporting clinical evidence to support appeal arguments when existing resources are unavailable.
• Utilize pre-existing criteria and other resources and clinical evidence to develop sound and well-supported appeal arguments, where an appeal is warranted.
• Responsible for governmental payer audits, Medicaid MCO Audits, and Medicare Advantage audits (i.e RAC and Cost Outlier).
• Provides patterns or trends associated with denials and appeals to Denials Management leadership.
• Maintains understanding of payer contracts.
• Maintains clinical competency and current knowledge of regulatory and payor requirements to perform job responsibilities.
• Collaborates with other departments, such as Case Management and MPA practices, in regards to appeals and denials.
• Contributes to team effort by accomplishing related results as needed.

Work Schedule: 80 hours bi-weekly

Qualifications /Training:

• Working knowledge of managed care terminology, managed care reimbursement methodologies, and billing/coding terminology (i.e. ICD-10, CPT, Revenue Code) preferred.
• Procedural knowledge of Patient Financial Services.
• Understanding of basic revenue cycle.
• Excellent interpersonal, written and organizational skills required.
• Attention to detail and accuracy skills required.
• Microsoft Excel and Word knowledge required.
• Minimum of 2 years healthcare appeals experience preferred.

Licenses/Certifications/Registrations/Education:

Must possess a valid RN license.

About Us

Founded in 1906, McLeod Health is a locally owned and managed, not-for-profit organization supported by the strength of more than 900 members on its medical staff and more than 2,900 licensed nurses. McLeod Health is also composed of approximately 15,000 team members and more than 90 physician practices throughout its 18-county service area. With seven hospitals, McLeod Health operates three Health and Fitness Centers, a Sports Medicine and Outpatient Rehabilitation Center, Hospice and Home Health Services. The system currently has 988 licensed beds, including Hospice and Behavioral Health.

About the Team

If you would enjoy working in a dynamic environment and are looking for an opportunity to become part of a stellar team of professionals, we invite you to apply online today. We are an equal opportunity employer.

Job Info

• Job Identification 18627
• Job Category Nonclinical Professional
• Posting Date 03/13/2025, 05:57 PM
• Degree Level Some College
• Job Schedule Full time
• Locations 800 E Cheves St, Florence, SC, 29506, US (On-site)