Recognized for Excellence. Chosen for Caring.
Human Resources: 700 Lawn Avenue, Sellersville, PA 18960  |  215-453-4874
Appeals Coordinator - Case Management
Full Time, 7:30am-4pm, Monday-Friday
Sellersville, PA 18960
Express Your
Interest
In Less Than 60 Seconds!

Responsibilities

Under the general direction of the Manager of Case Management, the Appeals Coordinator manages the third-party appeal process. The Appeals Coordinator is responsible for maintaining and updating correspondences and receipt acknowledgments within files and database.

Essential Functions:
  • Processes third-party denials/appeals upon notification of an insurance denial, either by the Case Manager or the insurance company.
  • Manages third-party appeals and denials in the Case Management and MEDITECH databases in order to provide accurate reporting at various hospital committees.
  • Completes data entry for all Denial and Appeal Management processes.
  • Maintains all correspondences and receipt acknowledgments to ensure receipt by payors.
  • Coordinates the telephonic and written appeal processes with Case Management staff, physician advisors and payors.
  • Manages the Retro Appeal process for the department (RAC, MAC, QIC, commerical payors, etc.).
  • Assists in the build and maintenance of department databases as needed.
  • Prepares and analyzes reports using Excel and department software for department and committee reporting.
  • Works with Business Office to investigate and resolve outstanding utilization review/reimbursement issues.
  • Participates as a team member in establishing procedures relating to Case Management functions to promote efficient operations.
  • Demonstrates ability to prioritize work assignments in order to meet deadlines and maintain timely department operations.
  • Performs Case Management Technician's functions in her absence to ensure continuity in Case Management department.
  • Communicates denial trends to Case Management leadership.

Qualifications

EDUCATION AND EXPERIENCE:
  • High school diploma/GED and 1-3 years of business experience in healthcare billing. Prefer knowledge of billing, case management coding, precertification, contracts, financial account reconciliation and insurance payor regulations (commercial and government).

BENEFITS:
  • Medical, free dental, vision insurance for full time and part time
  • 403B
  • Pension plan
  • On-site discounted child care center
  • Tuition reimbursement up to $5250 per year
  • Free life insurance
  • Free parking
  • Paid time off
  • Sick time
  • Flexible spending accounts
  • Employee referral bonus
Express Your
Interest
In Less Than 60 Seconds!
Grand View Health is an equal opportunity employer.
Career, Employment, Jobs, Opening, Staff, Department, Unit, Office, Occupation, Compensation, Salary, Benefits, Hospital, Health Care, Clinic, Healthcare, Physician, Medical, Clinical, Accounts Payable, A/P, Receivable, A/R, Collection, Collections, Accounting, Finance, Financial, Billing, Reimbursement, Payment, Bill, Insurance, GAAP, Generally Accepted Accounting Principles, Accountant, Certified Public Accountant, CPA, Business, Analysis, Analyst
Heather Bio Photo
"At Grand View, you are more than just a number. You are a person… a professional with a voice."
Heather M., Physical Therapist
More Jobs
Insurance Verification Specialist - Patient Registration | Full Time, 9am-5:30pm, Monday-Friday
Registrar - Patient Registration | Full Time, Days - Mon-Fri, 7am-3:30pm, every other weekend & holiday
Trauma Registrar | Full Time, Days - Mon-Fri with ability for some flexibility in hours & weekend time, if desired. After training is completed, hours can be split between office & remote.
Registrar - Patient Registration | Full Time, Evenings - 3pm-11:30pm, every other weekend & every other holiday
Patient Access Team Lead - Patient Registration | Full Time, Days - Flexible days & hours to fit leadership & operational needs
Certified Cancer Registrar - Oncology Information | Full Time, Days - Mon-Fri, 8am-4:30pm; hours are very flexible, hybrid flexibility
Quality Assistant, Telemetry | Per Diem, Variable - Committed - Work a minimum of 24 hours (or 3 7.5-hour shifts) per 6-week schedule on home unit with at least one 7.5- to 12-hour shift being a weekend shift. Work 7.5 hours of holiday time per year on home unit (holiday time is defined as Thanksgiving, Christmas, Memorial Day, July 4th or Labor Day). The holiday time is at the discretion of the Department Manager based on the unit need.
Registrar - Patient Registration | Per Diem, Varies - Non-Committed - As needed to cover shifts for outpatient & ED registration
Trauma Registrar | Per Diem, Variable - Non-Committed - Work can be done 24/7, any time, day or night
Patient Service Representative, Radiology | Per Diem, Evenings - Non-Committed - As needed, 3pm-7pm
Site Map  |  Cookie Policy  |  www.GVH.org  |  For GVH Managers  |  © Grand View Health. All rights reserved.