Insurance Appeals Coordinator - Day Shift - Remote Hybrid Position! - Munson Healthcare

Description

Insurance Appeals Coordinator

This position is primarily remote, but does require occasional travel to hospitals in Grayling, Gaylord, and Charlevoix, Michigan.

ENTRY REQUIREMENTS

Associates degree in business or health related degree or at least five (5) years especially in health insurance fields required.

Demonstrates ability to work independently and the ability to problem-solve with minimal supervision.

Ability to pull data from all of Munson Medical Center databases, tabulate and analyze data with minimal supervision.

Ability to act on insurance companies findings and initiate an appeal process.

Coordinates data/responses from all departments involved/mentioned in the appeals process.

Proven organizational skills and can work within strict time frames.

Effective in written and verbal communication skills.


ORGANIZATIONAL RELATIONSHIP

Report to the Manager of Utilization Management.

Interacts independently with all Munson Health Care departments.


POPULATIONS SERVED COMPETENCIES, INCLUDING AGE OF PATIENTS SERVED

No direct clinical contact with patients


SPECIFIC DUTIES

1. Supports the Mission, Vision and Values of Munson Healthcare

2. Embraces and supports the Performance Improvement philosophy of Munson Healthcare.

3. Promotes personal and patient safety.

4. Has basic understanding of Relationship-Based Care (RBC) principles, meets expectations outlined in Commitment To My Co-workers, and supports RBC unit action plans.

5. Uses effective customer service/interpersonal skills at all times

6. Designs and implement communication methods between departments to assimilate data/information to be used in the appeal process.

7. Tracks outcomes and trend recurring denial patterns and communicate this finding to the department(s) involved.

8. Identify and facilitate appeal response with individual departments/clinical experts.

9. Monitors, records and coordinates all follow-up requirements.

10. Communicates results of appeal with finance department, patient accounts and departments involved.

11. Summarizes results of appeals every 6 months, i.e. protected revenue.

12. Performs all other duties as assigned.