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Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Summary:

+ The Clinical Appeals Coordinator will play an essential role in maximizing collection of revenue for patient cases. They will provide oversight to the process and assist the Case Managers' at PAH in this important departmental process. They will oversee the appeals and denial process from beginning to end.The Coordinator will work closely with the Director, Physician Advisors and Clinical Resources Management's Team Leads to ensure billing of appropriate level of care for all patients in the hospital.

Responsibilities:

+ Reviews denied days to identify opportunities for appeal. Works closely with CM's and Physician Adviser to identify those cases with maximum appeal potentialComposes appeal letters utilizing IS and SI criteria, reviews medical records and EPIC documentation to defend appealsCollaborate with physician to support appeal of casesReviews denial letters daily. Assures EPIC denial accurately reflects third party payer lettersCollaborates with Physician Adviser in denial activity review. Prepares and participates in presentations to faculty on denial trends and activityFacilitate communication between Finance, Business Office, and Quality improvement office for monthly and quarterly reports. Assures reports are timely and accurate.Interacts with Patient Accounting to assure maximum revenue enhancement.Develops, implements, reports monthly denials and appeal activity while assuring deadlines for reporting are met.Analyze denial trends by service, payer, and physician. Produce reports as required related to third party payer activity.Function as CM in times of personnel shortages.Coordinator is responsible for management of lists and processes related to denials and appeals.Coordinator also prepares quarterly denial reports by service as requested. Coordinator participates in Medicare and Medicaid chart reviews for medical necessity.

Credentials:

+ PA State Licensed Registered Nurse required.

Education or Equivalent Experience:

+ Bachelors degree in Nursing and 5+ years Working as a RN Case Manager and /or Appeals Coordinator required.

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

REQNUMBER: 264640