Clinical Appeals Review Coordinator
Location: Franklin, Tennessee
Description: Community Health Systems (CHS) is at present looking to employ Clinical Appeals Review Coordinator right now, this vacancy will be assigned in Tennessee. Detailed specification about this vacancy opportunity kindly see the descriptions. 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 131 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 Review Coordinator for its Franklin, TN, headquarters’ Quality and Clinical Transformations team. The Clinical Appeals Review Coordinator is responsible for review of medical records, draft and finalization of Levels I and II medical necessity denial appeals for all CHS hospital RAC medical necessity denials and other medical necessity denials as requested. The Clinical Appeals Review Coordinator may be required to participate in Administrative Law Judge Hearings. Essential Duties and Responsibilities include the following. Other duties may be assigned. Appeals Processes Works with the Clinical Appeals Director, Unit physicians, and other team members to research, develop and maintain a structured standardized process for writing medical necessity appeals. Conducts thorough evidence based clinical literature research for all appeals to support appeal processes. Maintains, through Compliance 360 software, tracking of all appeals stages. Monitor appeals timelines for timely submission of appeals to fiscal intermediaries. Meets appeals filing deadlines. Works with clerical support and hospital staff to obtain medical records, documentation and required supporting information to write appeals. Maintains a working mastery of the use of InterQual criteria. Maintains current up to date knowledge of the legislative and CMS current trends in RAC, Medicaid Integrity and other denial processes. Provides education and support to hospitals when assigned. Assists the Clinical Appeals Unit Director in providing feedback to CHS corporate and facilities regarding current results. Assist the Clinical Appeals Unit director with maintaining physician and hospital specific reports quarterly. Appeals Software Works with the Clinical Appeals Unit Director to Ensure Compliance 360 has the necessary fields for appeals reporting and data collection. Makes suggestions for changes to the Clinical Appeals Unit Director as needed. Maintains a level of expertise in the use of Compliance 360 tracking software.
- .
If you were eligible to this vacancy, please give us your resume, with salary requirements and a resume to Community Health Systems (CHS).
Interested on this vacancy, just click on the Apply button, you will be redirected to the official website
This vacancy will be opened on: Sun, 05 Aug 2012 08:12:18 GMT
Apply Clinical Appeals Review Coordinator Here