Denial and Appeals Coordinator Full Time North Florida

Kindred Healthcare•Philadelphia, PA

About The Position

The Denials & Appeals Coordinator drives timely, effective denial management in coordination with utilization management and other teams. This non-clinical role supports denial prevention and resolution for designated facilities by monitoring concurrent reviews for continued-stay authorizations, tracking potential issues, and ensuring timely follow-up. The coordinator organizes and reports denial activity and partners with case management, the Centralized Business Office, managed care, facility controllers, Clinical Denials Management, and Regional leadership to ensure communication, task completion, and timely resolution. The position contributes to quality improvement, problem solving, and productivity enhancement in an interdisciplinary setting. The coordinator serves as a subject matter expert in denial prevention and coordination for the Central Access and Authorizations Team (CAAT). Duties include gathering clinical information from medical records, maintaining and submitting denial documentation, coordinating peer-to-peer consultations, tracking insurance denials and authorization outcomes, and supporting root-cause analysis and reporting. The role also monitors certified days and concurrent-review processes, identifies trends and improvement opportunities, maintains knowledge of payer practices and reimbursement, and develops familiarity with CAAT admission, scheduling, and pre-registration processes and systems.

Requirements

High school diploma or equivalent, including education equivalent to completion of secondary school, or demonstrated ability to perform the essential functions of the role.
At least 2 years of healthcare experience.
Team-oriented approach and ability to communicate professionally and demonstrate a professional image and attitude.
Excellent oral and written communication and interpersonal skills.
Strong computer skills with standard and proprietary applications.
Accurate data-entry skills with attention to detail.

Nice To Haves

Associate degree or higher in a healthcare-related field.
Licensed healthcare provider with equivalent experience may be considered.
Prior experience in case management, medical records, billing, utilization review, or admissions.
Prior experience in post-acute care and long-term acute care.

Responsibilities

Serve as a key member and denial-prevention subject matter expert for the Central Access and Authorizations Team (CAAT).
Work with facilities to gather clinical information from medical records, including printing and scanning information into required systems as needed.
Ensure denial-related documentation is complete, accurate, and submitted within required timeframes.
Collaborate with CAAT, Business Development, Case Management, and Clinical Teams in the denial management process.
Coordinate and schedule peer-to-peer physician consultations, working with case management or the physician advisory group as appropriate.
Monitor and track insurance denials and identify trends in the data.
Communicate authorization outcomes to appropriate hospital and Centralized Business Office personnel.
Manage denial root-cause analysis efforts as requested, including capturing lessons learned, identifying training opportunities, and communicating and following up with teams.
Monitor concurrent review processes for continued-stay authorizations and identify potential denial risks.
Compile data to analyze trends and opportunities by hospital, payer, or region.
Monitor and track total certified days for managed payers and communicate missing certifications to hospital personnel.
Identify facility-, payer-, and staff-specific trends and opportunities related to concurrent review and denials.
Compile and communicate denial-trend reports for facilities and leaders to support continuous improvement.
Support ongoing analytics and data-reporting requirements.
Maintain working knowledge of government and non-government payer practices, regulations, standards, and reimbursement.
Maintain clinical knowledge to support the utilization management team.
Participate in continuing education and professional development activities.
Learn the CAAT admission processes and seek to improve them continuously.
Learn scheduling and pre-registration routines in Meditech and other referral platforms used by the CAAT team, such as Referral Manager.
Perform other assigned duties within the scope of the CAAT team.