Impactful Utilization Appeals Specialist

01 ETCH East Tennessee Children's Hospital Association, Inc.; United States; On-site; USD 65,000 - 90,000; Full time

Job summary

East Tennessee Children's Hospital is seeking a skilled appeals specialist to manage concurrent and retrospective patient account denials within the Utilization Management framework. You will coordinate with E-HR for peer reviews, process and track appeals, and contribute to committee data analysis.

Ideal candidates have RN licensure or RHIA, 5+ years in Utilization Review, and strong communication in a fast-paced hospital setting.

Qualifications

• Associates degree required; bachelor's preferred.
• RN licensure in Tennessee or RHIA required.
• 5+ years Utilization Review experience.

Responsibilities

• Review appeals from Utilization Management Coordinators.
• Submit concurrent reviews to E-HR for peer-to-peer calls.
• Process retrospective reviews and transmit to E-HR by mail or fax.
• Maintain denial/appeal spreadsheets and prepare monthly data.

Skills

Computer skills

Time management

Interpersonal skills

English proficiency

Education

Associates degree

Bachelor's degree preferred

Tools

Meditech EHR

Job description

East Tennessee Children's Hospital is seeking a skilled appeals specialist to manage concurrent and retrospective patient account denials within the Utilization Management framework. You will coordinate with E-HR for peer reviews, process and track appeals, and contribute to committee data analysis.

Ideal candidates have RN licensure or RHIA, 5+ years in Utilization Review, and strong communication in a fast-paced hospital setting.