UM Appeals Coordinator – Drive Patient Account Resolutions

East Tennessee Children's Hospital; United States; On-site; USD 65,000 - 90,000; Full time

Job summary

East Tennessee Children\'s Hospital is seeking an experienced Appeals Coordinator to perform concurrent and retrospective reviews of patient account denials. The role reports to the Director-Health Information Management and requires RN licensure in Tennessee or RHIA, plus 5+ years in Utilization Review.

You will manage appeals data, coordinate submissions to external entities, and collaborate with physicians, providers, and managed care organizations to support denials resolution.

Qualifications

• RN Licensure in the State of Tennessee OR RHIA required.
• Minimum Education: Associate degree required; Bachelor's preferred
• Degree in Nursing or Health Information Administration
• Minimum 5+ years Utilization Review experience
• Strong computer, interpersonal, and communication skills; ability to interact with diverse backgrounds
• Excellent English grammar and spelling skills

Responsibilities

• Review appeals from Utilization Management Coordinators.
• Submit concurrent reviews to EHR peer processes; coordinate peer-to-peer calls.
• Process retrospective appeals and forward to EHR by mail or fax.
• Maintain an up-to-date appeals spreadsheet (concurrent, retrospective, external, second level).
• Enter appeal/denial data into Meditech EHR accurately.
• Prepare monthly denial/appeal data for Utilization Management Committee.
• Assist precertification during high volume periods and staff shortages.
• Actively participate in the Utilization Management Committee and liaise with physicians and external providers.

Skills

Computer skills

Interpersonal skills

Communication

English grammar

Education

Associate degree

Bachelor's degree preferred

Degree in Nursing or Health Information Administration

Tools

Meditech EHR

Executive Health Resources (EHR)

Job description

East Tennessee Children\'s Hospital is seeking an experienced Appeals Coordinator to perform concurrent and retrospective reviews of patient account denials. The role reports to the Director-Health Information Management and requires RN licensure in Tennessee or RHIA, plus 5+ years in Utilization Review.

You will manage appeals data, coordinate submissions to external entities, and collaborate with physicians, providers, and managed care organizations to support denials resolution.