APPEALS COORDINATOR at KidsPeace Childrens Hospital – Schnecksville, Pennsylvania

Job Summary

The Appeals Coordinator reviews all adverse decisions regarding continued stay and insures appropriate action is taken to maximize revenues for KidsPeace while maintaining the integrity and ethics of KidsPeace Corporation. The Appeals Coordinator also acts as a liaison between KidsPeace and external funding sources. The Appeals Coordinator functions as the point of contact for contracting needs of medical managed care companies for medical assistance.

Job Duties

• Prepare and coordinate specified denials for appeal/grievance with the appropriate managed care organization, including assurance that the client or the client’s guardian has signed the appropriate authorizations
• Complete appeal letter to be sent to the appropriate managed care organization and communicate with all parties throughout the appeals/grievance process
• Document and maintain the denials worksheet
• Ensure that the policies and procedures are being followed throughout the KidsPeace programs
• Serve as the liason/point person regarding any concerns/issues/problems between KidsPeace and managed care organizations and foster a positive working relationship between them
• Prepare and participate in chart audits, provider profiling and onsite visits by managed care organizations
• Coordinate contracting with medical assistance managed care organizations for the purposes of the provision and billing of medical services by KidsPeace physicians

Qualifications

• Bachelor's Degree in related field preferred; High School diploma and experience in related field required
• Experience with managed behavioral healthcare
• Knowledge of Federal and State laws related to the managed care industry