Denials and Appeals Coordinator Full Time North Florida

Kindred Healthcare•Green Cove Springs, FL

About The Position

The Denials and Appeals Coordinator is a nonclinical operational role responsible for coordinating timely denial prevention and resolution, with particular focus on continued-stay authorization reviews. As a key member and subject matter expert of the Central Access and Authorizations Team (CAAT), the coordinator tracks denial activity, identifies potential authorization issues, and ensures documentation, follow-up, and communication are completed on time. The role works with utilization management, facility teams, case management, the Centralized Business Office, managed care, facility controllers, Clinical Denials Management, Business Development, clinical teams, and regional leadership. It supports denial analysis and root-cause review, compiles and communicates reports, monitors certified days and concurrent review processes, and helps identify trends and opportunities for improvement. The coordinator also develops working knowledge of CAAT admission processes and scheduling and preregistration routines in Meditech and other referral platforms. The position reports to a building and may cover more than one building depending on market alignment and structure. Travel is listed as approximately 0%25.

Requirements

High school diploma or GED required.
At least 2 years of healthcare experience.
Fluent in spoken and written English.
Excellent oral and written communication and interpersonal skills.
Strong computer skills with standard and proprietary applications.
Accurate data-entry skills and attention to detail.
Ability to communicate professionally and demonstrate a professional image and attitude with patients, families, clients, coworkers, and others.
Good and regular attendance.
Adherence to ScionHealth policies and practices.

Nice To Haves

Associate or bachelor's degree preferred, particularly in a healthcare-related area of concentration.
Licensed healthcare provider or equivalent experience preferred.
Experience in case management, medical records, billing, utilization review, or admissions is a plus.
Post-acute care and long-term acute care experience is a plus.

Responsibilities

Serve as a key member and subject matter expert on denial prevention and coordination for the Central Access and Authorizations Team (CAAT).
Work with facilities to gather clinical information from medical records, including printing and scanning documents into required systems when 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 as needed, working with case management or the physician advisory group as appropriate.
Monitor and track insurance denials and identify trends in denial data.
Communicate authorization outcomes to appropriate hospital and Centralized Business Office personnel.
Manage denial root-cause analysis efforts as requested, 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, including commercial, managed government, and Medicaid payers, and communicate missing certifications to hospital personnel.
Identify trends and opportunities related to concurrent review processes and denials involving facilities, payers, and staff members.
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 and develop full knowledge of CAAT admission processes and actively seek to improve them.
Learn and maintain a full understanding of scheduling and preregistration routines in Meditech and other referral platforms used by CAAT, such as Referral Manager.
Perform other ad hoc duties within the scope of the CAAT team.
Conduct job responsibilities in accordance with the company’s Code of Business Conduct, policies and procedures, Corporate Compliance Agreement, applicable laws, and applicable professional standards.