Working under the direction of the Director of Compliance with minimal supervision, the Compliance and Appeals Coordinator is primarily responsible for record keeping of government appeals and deadlines, coordinating with outside vendors for appeals, reconciliation of appeal databases to ensure accuracy and timeliness, assist in Compliance related audits and investigations. This includes understanding and familiarity with healthcare privacy and security laws, regulations and standards. These duties will require the understanding of many complex and varying guides, systems, regulations and tools. The Compliance and Appeals Coordinator will use critical thinking skills to manage an ever evolving process that includes financial, clinical and medical/legal components. The Compliance and Appeals Coordinator will proactively work with MemorialCare staff and physicians to ensure areas impacted by retrospective denials or compliance related investigations in professional and courteous manner.
Duties & Responsibilities:
Maintain a fast paced process of requests and acknowledgements for data and correspondence.
Must be able to identify and correct weaknesses in the process and alert management in the event of potential technical denials due to not meeting date sensitive deadlines
Coordinates with management to identify and correct weaknesses in the process that can mitigate future denials.
Stays current on trends related to Medical Necessity, DRG and Automated Denials by the RAC and MIP by attending conferences, seminars and audio conferences.
Tracks government appeal requests from ADR requests to closure
Maintains tables and databases associated with appeals process and deadlines
Stays current on trends related to all government sponsored programs
Coordinates with management to identify & correct weakness in processes
Performs scheduled reconciliations of the tracking tool
Completes compliance related projects and audits thoroughly and with the utmost confidentiality
Experience & Qualifications:
Must have a clinical or patient accounting background with a fundamental knowledge of the Revenue Cycle Process which includes; Patient Access, Case Management/Utilization Review, Charge Capture, HIM, Patient Accounting for minimum of 3 years.
Ability to communicate effectively
Excellent analytical and critical thinking skills, details oriented