Clinical Appeals Team Lead occupation at CHS Corporate in Franklin

CHS Corporate is at the momment seeking for Clinical Appeals Team Lead on Thu, 01 Aug 2013 21:47:30 GMT. Clinical Appeals Team Lead - 1344003 Description Community Health Systems Professional Services Corporation is one of the leading operators of general acute care hospitals. The organization's affiliates own, operate or lease 135 hospitals in 29 states, with an aggregate of approximately 19,800 licensed beds. The consolidated organization owns and leases community hospitals that offer quality...

Clinical Appeals Team Lead

Location: Franklin, Tennessee

Description: CHS Corporate is at the momment seeking for Clinical Appeals Team Lead right now, this occupation will be reside in Tennessee. For detail informations about this occupation opportunity kindly see the descriptions. -

1344003

Description

Community Health Systems Professional Services Corporation is one of the leading operators of general acute care hospitals. The o! rganization's affiliates own, operate or lease 135 hospitals in 29 states, with an aggregate of approximately 19,800 licensed beds. The consolidated organization owns and leases community hospitals that offer quality, cost-effective healthcare including a range of inpatient medical and surgical services, outpatient treatment and skilled nursing care. In over 60 percent of the markets served, CHS-affiliated hospitals are the sole provider of healthcare services.

Community Health Systems Professional Services Corporation seeks a

Clinical Appeals Team Leader

for its Franklin, TN, headquarters’

Central Appeals Unit

team.

SUMMARY

The team leader is responsible for the coordination of audit and medical necessity denial appeals for their assigned team, ensuring timely and appropriate appeal responses and accurate data entry into C360. The team leader is responsible for managing assigned appeals team as relates to day! -to-day assignments, implementation of established processes, ! and problem-solving to ensure daily goals in service and production are met. They will identify denial trends and compliance risk and work closely with the Senior Director of Appeals to coordinate activities that ensure regulatory compliance and foster a reduction in denial risks.

Essential Duties and Responsibilities

Appeals Processes

  • In collaboration with the Senior Director of Appeals and physician advisors, develop and maintain structured standardized processes for receipt and assimilation of hospital RAC and other auditor correspondence, record review and creation of medical necessity appeals
Conducts evidence based research, if indicated, for most common denial reasons to support appeal processes

  • Provide guidance and supervision to assigned team to appropriately appeal all denials in which the medical record contains documentation to support the inpatient stay and services provided
  • Monitor and m! aintain oversight of assigned team to ensure timely submission of appeals to fiscal intermediaries in order to meet deadlines for all appeal levels
  • Ensure coordination of the appeals process by communicating directly with Recovery Audit Contractors, if indicated, including requests for documentation and filing of responses and levels of appeals
Maintain up to date knowledge of the legislative and CMS current trends in RAC, Medicaid Integrity and other denial processes

  • Recognize changes in RAC/audit processes in order to adjust process flow in the CAU. Assist with the development and provision of instruction and education to CHS and hospital staff regarding such changes
Participate in Administrative Law Judge hearings, as needed

Maintain a working mastery of the use of InterQual criteria.

In collaboration with the Central Appeals Unit Operations Manager and the Senior Director for Appeals, ensure Compliance 3! 60 has the necessary fields for appeals reporting and data collection. ! Make recommendations for changes as needed

Maintain a level of expertise in the use of Compliance 360 tracking software

Staff Leadership/Development

  • Coach team members to improve performance
  • Identify individual shortcomings of team members and help them through customized coaching
  • Participate in the hiring and annual performance evaluation of assigned team members
Qualifications

BSN required or must be enrolled in BSN program or actively in pursuit of BSN.
RN licensure in the State of _______ required.
Case Management certification desirable.
One (1) to three (3) years experience in discharge planning, utilization management and/or reimbursement required.
Strong demonstrated knowledge of community health services required.
Experience or training in critical pathways, clinical guidelines, outcomes management and demonstrated clinical expertise and experience with complex discharge p! lanning required.
Demonstrated knowledge of InterQual criteria preferred.
Demonstrated proficiency with personal computers, with word processing
Demonstrated excellent interpersonal, organizational and communication skills and ability to collaborate effectively with physicians and other members of the healthcare team required.
Demonstrated ability to orchestrate many activities and manage multiple priorities required.

Job

Quality

Primary Location

TN-Franklin (Nashville Region)

Organization

CHS Corporate

Shift

Day Shift

Forecasted paid hours per shift

8

Forecasted hours per pay week

40

Employee Status

Full-time
- .
If you were eligible to this occupation, please send us your resume, with salary requirements and a resume to CHS Corporate.

Interested on this occupation, just click on the Apply button, you will be redirected to the official website

This occupation starts available on: Thu, 01 Aug 2013 21:47:30 GMT



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