Clinical Resource Management, Appeals Coordinator
GENERAL SUMMARY Responsible for coordinating and monitoring the denial management and appeals process. Combines clinical, business and regulatory knowledge and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided. Collaborates with physicians, case managers, revenue cycle personnel and payers to appeal denials. EDUCATION: Bachelor's Degree from an accredited school of nursing is required. PRIOR EXPERIENCE: Minimum of three to five years as clinical nurse in an acute care setting. Extensive knowledge of clinical symptomotology and related treatment and hospital utilization management. Knowledge of current reimbursement models: commercial, managed care, Medicare, Public Assistance. Technical writing ability for appeal letters and reports. CERTIFICATION/REGISTRATION/LICENSURE: Current RN license.