Appeals Coordinator

Overview

The Appeals Coordinator plays an integral role in optimizing the patient’s recovery journey by providing a comprehensive review of a member’s clinical information in response to an appeal from the Quality Improvement Organization (QIO) or the Health Plan. The Appeals Coordinator is responsible for writing the DENC (Detailed Explanation of Non-Coverage) or preparing an appeal response package once an appeal has been filed. Required: • Current Licensure as a Physical, Occupational, or Speech Therapist (PT, OT, or ST), or Registered Nurse (RN) • Current active unrestricted clinical license required • Bachelor’s degree in healthcare-related field or equivalent work experience • At least two years’ recent experience in case-management or utilization management. • 3-5 years clinical experience in a relevant discipline (i.e., RN, OT, PT, ST). The nice to haves…… • Multiple state nursing licenses (if RN) • ICD-9 and InterQual experience a plus. • CMS knowledge preferred. • Experience with appeals processing. • Current knowledge of multiple nH contracts.

Benefits

Company

Since 2012, this client has been a trusted partner for the nation’s top health plans, health systems, post-acute care providers, and at-risk physician groups navigating the shift from volume to value. Their high-touch, proven care model fully supports patients from pre-acute through to the home. This client's patients can enjoy more days at home, and healthcare providers and health plans can significantly reduce costs specific to unnecessary care and readmissions.