Title: Clinical Appeals Coordinator
Department Org: Patient Financial Svcs - 108870
Employee Classification: J1 - Salaried Full Time HSC
Bargaining Unit: Bargaining Unit Exempt
Primary Location: Health Science Campus Support
Shift: 1
Start Time: 8 AM End Time: 430 PM
Posted Salary:
Float: False
Rotate: False
On Call: False
Travel: False
Weekend/Holiday: False
Job Description:
Clinical Appeals Coordinator will perform comprehensive analytical review of clinical documentation to manage payer appeals. To include advisory services and assistance to facilitate the appeal process for reimbursement from third party payers. Position requires data collection and analysis in the preparation of appeals and quality assurance activities. Root Cause analysis to identify trends and process improvement recommendations required for monthly reporting. Combination of clinical experience from an acute care setting and/or experience handling appeal responses to third party payers addressing clinical denials preferred.
Minimum Qualifications:
Qualifications/Knowledge, Skills & Abilities
• Position requires minimum of 1 year of comprehensive knowledge of applicable Federal, State and commercial insurance regulations, insurance plans, member eligibility and medical billing or collections.
• 1-3 years of case management, chart review/audit or precertification experience.
• 1-3 years of clinical operations, charge creation, processing and reconciliation in a healthcare environment.
• Minimum of 1 year experience of industry standard coding and billing methodologies, including CPT, HCPCS and ICD codes.
Education/experience/licensing
• Registered Nurse preferred or current state registered LPN license.
• Minimum 3 years clinical nursing.
• Preferred 3 years of coding, billing and DRG reimbursement with knowledge of third party billing requirements.
Communication and Other Skills
Exceptional written, verbal and interpersonal communication skills. Ability to articulate information in a clear and informative manner required.
Conditions of Employment:
All UToledo employees on all campuses, including those working on campus and working remotely, are required to be fully vaccinated against Covid-19, or have an approved exemption.
To promote the highest levels of health and well-being, the University of Toledo campuses are tobacco-free. To further this effort, the University of Toledo Health Science Campus Medical Center is requiring candidates for employment to be nicotine-free. Pre-employment health screening requirements will include cotinine (nicotine) testing, as well as drug and other required health screenings for the position. With the exception of positions within University of Toledo Main Campus and the University of Toledo College of Medicine and Life Sciences, the employment offer is conditional upon successful completion of a cotinine test and Occupational Health clearance.
Equal Employment Opportunity Statement:
The University of Toledo is an equal opportunity, affirmative action employer. The University of Toledo does not discriminate in employment, educational programs, or activities on the basis of race, color, religion, sex, age, ancestry, national origin, sexual orientation, gender identity and expression, military or veteran status, disability, familial status, or political affiliation.
The University is dedicated to the goal of building a culturally diverse and pluralistic faculty and staff committed to teaching and working in a multicultural environment and strongly encourages applications from women, minorities, individuals with disabilities, dual-career professionals and covered veterans.
The University of Toledo provides reasonable accommodation to individuals with disabilities. If you require accommodation to complete this application, or for testing or interviewing, please contact the Human Resources Department at 419-530-4747 between the hours of 8:30AM and 5:00PM or apply online for an accommodation request.
Computer access is available at most public libraries and at the Office of Human Resources located in the Center for Administrative Support on the Main Campus of the University of Toledo.
