Clinical Appearls Coordinator-PT

University of Mississippi Medical Center•Clinton, MS

7d•Onsite

About The Position

Coordinates and supports the billing process, including denial and appeal reviews. Evaluates and monitors patient care payment denials and related claims while supporting the development of strategies to minimize financial risk through effective appeals management. Conducts research, collaborates with departments to verify denials, perform clinical reviews, and prepares reports to support quality improvement initiatives and prevent future denials.

Requirements

Two (2) years of nursing experience.
Valid RN license.
Knowledge and understanding of clinical organization structure, workflow, and operating procedures.
Skill in the use of personal computers and related software applications.
Ability to manage multiple priorities under time constraints; ability to analyze and solve problems.
Understanding 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 and case management experience.

Responsibilities

Reviews patient medical records and collects data to support billing and appeals management, analysis, and monitoring activities.
Communicates with insurers to determine the appropriateness of payments or denials.
Collects, reviews, and submits timely appeals for medical necessity and authorization of denials.
Conducts clinical research and analysis to identify issues and develop strategies that improve the payment and appeals process.
Assists with chart audits by reviewing and comparing medical records against itemized patient bills to ensure accuracy and maintain revenue integrity.
Analyzes denial and payment data to identify trends and patterns, supporting system-wide performance improvement and management education.
Supports quality improvement initiatives by reviewing clinical practices for consistency, adherence to policy, and appropriate levels of care across settings; prepares reports and communicates findings to clinical and non-clinical staff.
Communicates and negotiates with external stakeholders, including insurance payers, regarding appeal outcomes.
Maintains knowledge of current regulatory and accreditation standards related to denial and appeals management to support organizational compliance.
The duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.