Nuvance Health is a family of award-winning nonprofit hospitals and healthcare professionals in the Hudson Valley and western Connecticut. Nuvance Health combines highly skilled physicians, state-of-the-art facilities and technology, and compassionate caregivers dedicated to providing quality care across a variety of clinical areas, including Cardiovascular, Neurosciences, Oncology, Orthopedics, and Primary Care.
Nuvance Health has a network of convenient hospital and outpatient locations — Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York — plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care, and two urgent care offices. Non-acute care is offered through various affiliates, including the Thompson House for rehabilitation and skilled nursing services, and the Home Care organizations. For more information about Nuvance Health, visit www.nuvancehealth.org.
Title: Technical Appeal Coordinator
Reports To: Director-Denials Prevention and Management
Department: Patient Financial Services (System Business Office)
FLSA Status: Non-Exempt
Purpose: The Technical Appeal Coordinator, with a high degree of autonomy, will organize and coordinate office administration and procedures, to ensure departmental effectiveness. This includes maintaining intra-office communication protocols, streamlining administrative procedures, inventory control and support to staff and leadership.
1. Supports the daily operations of the department including, implementing office policies and standards, organizing and scheduling meetings and appointments and by carrying out the planning and execution of interdepartmental revenue cycle collaboration.
2. Runs and prepares reports and dashboards assisting with creating presentations for daily/weekly/monthly meetings relating to assigned work queues.
3. Maintain current resource links for all payer clinical criteria, payer reimbursement policies and abreast of payer bulletin updates.
4. Runs daily outpatient in scope 835 denial reports, identifies the appropriate work items.
5. Conducts full analysis of medical records vs. payer specific clinical criteria/policies to substantiate medical necessity requirements have been met.
6. Collaborating with clinical and managed care counterparts as necessary drafting all outpatient medical necessity appeals.
7. Track all outpatient in scope appellate outcomes providing root cause analysis to leadership including but not limited to: Executive, Department, Supervisor, etc.
8. Ensures claims inventory, outbound correspondence, and workflows are managed in accordance with State, Federal and Health plan regulatory requirements as well as departmental guidelines.
9. Responsible for providing lead support to the technical staff including training and substitute floating to cover technical positions.
10. Ensures appeals follow the hospital billing systems, billing forms and filing requirements, various payer contracts, Federal, State and managed care billing methodologies, rules and regulations, effective follow-up and collection approaches, timely payment regulations and holds payers accountable, hospitals’ patient accounting systems and payer policies, contracts and websites.
11. Demonstrates regular, reliable and predictable attendance.
12. Performs other duties as required.
13. Maintain and Model REACH Values (Respect, Excellence, Accountability, Compassion, Honor).
Education and Experience Requirements:
• High School Diploma or equivalent.
• Three to five (3-5) years’ experience in a fast-paced health care related field, heavily focused on medical necessity and payer appellate workflows.
• PREFER: Three to five (3-5) years’ experience in patient accounting.
Skills and Abilities Requirements:
• Knowledge of common medical terminology and insurance plan concepts.
• Excellent written and verbal communication skills.
• Time management skills with the ability to multi-task.
• Attention to detail and problem-solving skills.
• Proficient in MS Office (Word, Excel).
• Must be able to work independently, problem solve, manage stress, and prioritize work
• Ability to form positive, collaborative relationships with hospital staff, providers, patients and families.
License, Registration, or Certification Requirements:
• PREFER Certified Revenue Cycle Representative (HFMA - CRCR) or able to obtain within 6 (six) months of hire.
Factors affecting environment conditions may vary depending on the assigned work area and tasks. Potential environmental exposures include, but are not limited to:
• Chemicals/Commercial Products
• Experiencing challenging conditions where a professional attitude will be required
• Interacting with a Diverse population
• Noise Level – Varies from Quiet to Moderate
• Repetitive Motion
• Risk of Electrical Shock