Loading...
Share this Job

Appeals Processing Coordinator

Work Schedule/Days:  Day / Monday - Friday
Employment Type:  Full-Time
Location:  Support I 
Requisition #:  69405

 

JOB SUMMARY

Provides operational support to Revenue Cycle in areas of billing and appeals and completes multiple operational support tasks, including tracking all appeals, facilitating timely submission of appeals, and performing record keeping of all appeals. Works in partnership with other team members to provide quality service to proactively support efforts that ensure delivery of safe patient care and services and promote a safe environment at Children’s Healthcare of Atlanta.

EDUCATION

• Associate's degree in healthcare-related field or equivalent

CERTIFICATION SUMMARY

• No professional certifications required

EXPERIENCE*

• 1 year of experience in basic clinical medical record or coding

PREFERRED QUALIFICATIONS*

  • 2 years of experience in insurance billing and/or collections with a general knowledge of hospital business office functions
  • Knowledge of managed care billing
  • Knowledge of key Children's Healthcare of Atlanta patient accounting applications, e.g., EPIC Resolute, Dentrix Dental, Clearinghouse, or comparable system

KNOWLEDGE SKILLS & ABILITIES*

• Exceptional instruction skills with an attention to detail
• Strong written and verbal communication skills
• Ability to assess workload and prioritize
• Medical terminology
 

JOB RESPONSIBILITIES*

  1. Partners with Appeals Coordinators, Utilization Review, and Patient Accounts Managers to ensure payor appeals packages are created accurately for timely submission while maintaining patient confidentiality.
  2. Reviews appeals packages to ensure accuracy and completeness.
  3. Supports and helps coordinate documentation for administrative law hearing/settlement submissions.
  4. Provides continuous analysis of denials and operational support for appeals.
  5. Identifies payor denial trends and communicates issues and outcomes to appropriate areas.
  6. Assists Process Improvement Specialists, Appeal Coordinators, Utilization Review, department managers, and director to identify opportunities for improvement.
  7. Monitors and provides summary-level reporting to Appeal Coordinators and department leadership regarding critical functions of the area.
  8. Assembles appeals record in correct order, verifying that all materials belong to named patient and placing record in correct folder and sequence.
  9. Enters appeals statistics and updates into spreadsheets daily and monthly by payor to track and report volume, timeliness of appeals sent, and status.
  10. Ensures appeals are received by appropriately following up as needed.
  11. Facilitates obtaining medical records as needed to ensure appeals submission.
  12. Participates in training to ensure continuous improvement in appeals process.
  13. Assists with other tasks, e.g., loose filing, printing, and mailing.

SYSTEM RESPONSIBILITIES*

Safety: Practices proper safety techniques in accordance with hospital and departmental policies and procedures. Responsible for the reporting of employee/patient/visitor injuries or accidents, or other safety issues to the supervisor and in the occurrence notification system.
 
Compliance: Monitors and ensures compliance with all regulatory requirements, organizational standards, and policies and procedures related to area of responsibility. Identifies potential risk areas within area of responsibility and supports problem resolution process. Maintains records of compliance activities and reports compliance activities to the Compliance Office.
 
The above statements are intended to describe the general nature and level of work performed by people assigned to this classification.  They are not intended to be an exhaustive list of all job duties performed by the personnel so classified.

 

PHYSICAL DEMANDS*

Ability to lift up to 15 lbs independently not to exceed 50 lbs without assistance
Bending/Stooping - Occasionally (activity or condition exists up to 1/3 of time)
Climbing - Not Present
Hearing/Speaking - Effective communication with employees, supervisors/managers and staff. Effective communications with patients and visitors, as required.
Lifting - Occasionally (activity or condition exists up to 1/3 of time)
Pushing/Pulling - Occasionally (activity or condition exists up to 1/3 of time)
Sitting - Occasionally (activity or condition exists up to 1/3 of time)
Standing - Frequently (activity or condition exists from 1/3 to 2/3 of time)
Walking - Occasionally (activity or condition exists up to 1/3 of time)

WORKING CONDITIONS*

No potential for exposure to blood and body fluids

 

About Us:

Children’s Healthcare of Atlanta has been 100 percent committed to kids for more than 100 years. A not-for-profit organization, Children’s is dedicated to making kids better today and healthier tomorrow.

With 3 hospitals, 20 neighborhood locations and a total of 673 beds, Children’s is the largest healthcare provider for children in Georgia and one of the largest pediatric clinical care providers in the country. Children’s offers access to more than 60 pediatric specialties and programs and is ranked among the top children’s hospitals in the country by U.S. News & World Report.

Children’s has been recognized as a Fortune 100 Best Place to Work, a Best Place for Working Mothers, and as a top employer for diversity and millennials.  We offer a comprehensive compensation and benefit package that supports our mission, vision and values.  We are proud to offer an array of programs and services to our employees that have distinguished us as a best place to work in the country.  Connect to our mission of making kids better today and healthier tomorrow. 

Have questions about the recruitment process?  Check out What to Expect.

Address:  1575 Northeast Expressway, Bldg 1, Atlanta, GA  30329
Function:  Administrative/Clerical Supp - Patient Financial Services


Nearest Major Market: Atlanta

Job Segment: Medical, Clerical, EMR, Patient Care, Pediatric, Healthcare, Administrative