Boston, Massachusetts
Managed Care Appeal and Denials Management Coordinator Job Opening in Boston, Massachusetts - The Medicare/Managed Care Appeal and Denials Management Coordinator is responsible for oversight and management of Medicare and Managed Care appeals and denials. This position will be responsible for the identification, execution, tracking and trending of appeals and denials. The ideal candidate for this role will have amazing interpersonal and leadership skills. Please apply now!
Responsibilities:
Review medical records and utilize clinical/regulatory knowledge and payer requirements to asses why a case may have been denied
Investigate cases for supporting evidence to benefit appeal arguments
Provide follow up and communication throughout the appeals process
Maintain all information within the electronic database
Responsible for the assisting and writing of appeals at the Reconsideration and Redetermination level
Research claims for denial reasons, tracking and trending, and reporting of data trends
Provide education and act as a information resource regarding the appeal process
Maintain confidentiality in compliance with HIPPA regulations
Requirements:
Must be an RN or a Licensed Therapist, Speech/Language Pathologist
At least 5 years of experience in a leadership position within a healthcare setting
Demonstrated knowledge and exposure to the areas of Medicare, Managed Care, and Reimbursement
Must be knowledgeable in utilization review, medical terminology, appropriate level of care, treatment, modalities, statues, and healthcare delivery models
Proficiency in Microsoft Word, Excel, and PowerPoint
Expert knowledge of federal and state regulations
Strong knowledge of MDS process (RAC-CT preferred)
Understanding of compliance requirements
Seasoned clinical and critical thinking skills
Demonstrated time management skills
Ability to work independently and adapt quickly
Must have the ability to travel and be comfortable with a flexible working schedule
INDC
To apply, please send resumes to
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