Coordinator, Appeal & Denials - Care Coordination, Full-Time, Hyrbid

This position primarily supports Vineland and Elmer Medical Centers, supports Mullica Hill and Mannington Medical Centers as needed.

MAJOR FUNCTION:

The Denial and Appeals Coordinator tracks and coordinates third party payer activity and timeliness of organizational response. Identifies, analyzes, and reports denial trends to the department Director, Business Office, Compliance and Managed Care. Maintains monthly reports on internal UM trends including referral volumes and referral outcomes. Participate in Compliance Committee and Denials Committee meetings as appropriate. Serves as a resource to case managers relative to retrospective and concurrent denials and UM processes. Develop educational materials for UM team in conjunction with the Care Coordination Director. Serves as a liaison between case managers, payers, and internal physician advisors in response to payer issues. Collaborates with internal and external stakeholders to ensure compliance to state and ...