Appeals Processing Coordinator

Children's Healthcare of Atlanta•Brookhaven, GA

3d•Onsite

About The Position

Provides operational support to Revenue Cycle in areas of billing and appeals and completes multiple operational support tasks, including tracking all appeals, facilitating timely submission of appeals, and performing record keeping of all appeals. Works in partnership with other team members to provide quality service to proactively support efforts that ensure delivery of safe patient care and services and promote a safe environment at Children’s Healthcare of Atlanta.

Requirements

1 year of experience in insurance billing or collections, with a general knowledge of hospital business office functions
Exceptional instruction skills with an attention to detail
Strong written and verbal communication skills
Ability to assess workload and prioritize
Medical terminology
High school diploma or equivalent

Nice To Haves

2 years of experience in insurance billing and/or collections with a general knowledge of hospital business office functions
Knowledge of managed care billing
Knowledge of key Children's Healthcare of Atlanta patient accounting applications, e.g., EPIC Resolute, Dentrix Dental, Clearinghouse, or comparable system

Responsibilities

Partners with Appeals Coordinators, Utilization Review, and Patient Accounts Managers to ensure payor appeals packages are created accurately for timely submission while maintaining patient confidentiality.
Reviews appeals packages to ensure accuracy and completeness.
Supports and helps coordinate documentation for administrative law hearing/settlement submissions.
Provides continuous analysis of denials and operational support for appeals.
Identifies payor denial trends and communicates issues and outcomes to appropriate areas.
Assists Process Improvement Specialists, Appeal Coordinators, Utilization Review, department managers, and director to identify opportunities for improvement.
Monitors and provides summary-level reporting to Appeal Coordinators and department leadership regarding critical functions of the area.
Assembles appeals record in correct order, verifying that all materials belong to named patient and placing record in correct folder and sequence.
Enters appeals statistics and updates into spreadsheets daily and monthly by payor to track and report volume, timeliness of appeals sent, and status.
Ensures appeals are received by appropriately following up as needed.
Facilitates obtaining medical records as needed to ensure appeals submission.
Participates in training to ensure continuous improvement in appeals process.
Assists with other tasks, e.g., loose filing, printing, and mailing.