APPEALS/DENIALS CASE MGR

UHS•Brentwood, TN

11d

About The Position

Position Summary: This position is responsible for monitoring insurance denials by running relevant reports and documenting appeal results in MS4 and MIDAS, ensuring proper notification to providers and members. The individual oversees staff handling post-discharge provider authorization disputes and "take-backs" related to clinical authorization and closed chart denials. The role requires close coordination with HIM to retrieve charts and collaboration with facility clinicians to obtain missing information, ensuring a strong appeal case. Additionally, they manage the denials and appeals process for designated facilities within FRN, coordinating with facility and CBO personnel while maintaining accurate reporting documentation for staff and supervisors. About Universal Health Services One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $14.3 billion in 2023. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Headquartered in King of Prussia, PA, UHS has approximately 96,700 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

Requirements

High School Graduate/GED Required. Associate's Degree preferred
1-3 Years Related work experience required
Excellent verbal and written communication skills required.
Solid clinical background in providing substance abuse and or mental health treatment.
Familiarity with the utilization process involved in working with health plans.
Proficient in Microsoft Suite for word processing, spreadsheets, and presentations.
Good understanding of dual diagnosis treatment.

Responsibilities

Monitors insurance denials by running appropriate reports. Continuously and thoroughly documents in both MS4 and MIDAS the results of the appeals and dispositions at all levels including notification to providers and members.
Manages the staff responsible for all post-discharge provider authorization disputes, and provider “take-backs” due to clinical authorization and closed chart denial appeals
Works with HIM to retrieve charts and facility clinicians to obtain any missing information in a timely manner to ensure the best possible case for appeal is submitted.
Resolves issues associated with the appeals between other internal departments of the BO or external departments of the facilities served.
Manages caseload and is responsible for all post-discharge provider authorization disputes and provider “take-backs” due to clinical authorization and closed chart denial appeals on their caseload.