Clinical Appeals Coordinator | Concord Hospital | Part Time
Capital Region Health Care Corporation
Concord, USA
Review medical records for claim denials
Evaluate opportunities for education
Serve as clinical resource
The Clinical Appeals Coordinator is responsible for supporting Concord Hospital with claim appeal activities within the Revenue Integrity department
Job Summary
The Clinical Appeals Coordinator is responsible for supporting Concord Hospital with claim appeal activities within the Revenue Integrity department.
This involves a timely and accurate review of medical records in response to claim denials received from third party payers, Recovery Audit Contractors (RAC), Medicare Administrative Contractors (MAC), as well as medical necessity denials from other governmental and non-governmental payers and auditors.
The Clinical Appeals Coordinator will evaluate opportunities for education and provide feedback to physicians the RCC Committee, and other relevant departments.
Matching Summary
The Clinical Appeals Coordinator is responsible for supporting Concord Hospital with claim appeal activities within the Revenue Integrity department.
Skills & Requirements
Must-have
Review medical records for claim denials
Evaluate opportunities for education
Serve as clinical resource
Compose persuasive appeal using clinical data
Independent judgment in reviewing records
Strong organizational and time management skills
Nice-to-have
Collaborative work environment
Flexibility in changing demands
Motivational skills
Key Requirements
Bachelor's degree in Nursing
Minimum of five years’ experience in utilization review
Medicare audit and appeal background strongly desired