Clinical Appeals Coordinator - Part Time

University of Mississippi Medical Center • Clinton, MS

1d

About The Position

The Clinical Appeals Coordinator coordinates and supports the billing process, including denial and appeal reviews. The role evaluates and monitors patient-care payment denials and related claims, and supports development of strategies to minimize financial risk through effective appeals management. The coordinator researches denials, collaborates with departments on verification and clinical reviews, and prepares reports to support quality improvement and prevent future denials.

Requirements

• Two years of nursing experience.
• Valid RN license.
• Knowledge and understanding of clinical organization structure, workflow, and operating procedures.
• Skill in using personal computers and related software applications.
• Ability to manage multiple priorities under time constraints and analyze and solve problems.
• Understanding of cost and quality issues.
• Verbal and written communication skills.
• Interpersonal skills to interact with a wide range of constituencies.
• Decision-making skills.

Nice To Haves

• Utilization review experience.
• Case management experience.

Responsibilities

• Review patient medical records and collect data to support billing, appeals management, analysis, and monitoring activities.
• Communicate with insurers to determine the appropriateness of payments or denials.
• Collect, review, and submit timely appeals for medical-necessity and authorization denials.
• Conduct clinical research and analysis to identify issues and develop strategies to improve the payment and appeals process.
• Assist with chart audits by comparing medical records with itemized patient bills to ensure accuracy and maintain revenue integrity.
• Analyze denial and payment data to identify trends and patterns, supporting system-wide performance improvement and management education.
• Support quality improvement initiatives by reviewing clinical practices for consistency, policy adherence, and appropriate levels of care across settings; prepare reports and communicate findings to clinical and non-clinical staff.
• Communicate and negotiate with external stakeholders, including insurance payers, regarding appeal outcomes.
• Maintain knowledge of current regulatory and accreditation standards related to denial and appeals management to support organizational compliance.

What This Job Offers

• Job Type: Part-time
• Education Level: No Education Listed