• COORDINATOR-RAC APPEALS

    Location US-TN-MEMPHIS
    Posted Date 4 months ago(10/3/2019 10:23 AM)
    Position Code
    12472
    Day Shift
    Yes
    Night Shift
    No
    Rotating Shift
    No
    Evenings
    No
    Status
    Regular Full-Time
    Department
    HS REVENUE AUDIT
  • Overview and Responsibilities

    Reviews and evaluates medical documentation to support compliance and external regulatory requirements. Reviews denials and is responsible for the evaluation coorddination, and appeal of third party determinations and interventions pertinent to the reimbursement process, as well as other concerns that result from monitoring activities. Incumbent is also responsiblefor resolving issues as they occur. Performs other duties as assigned.  #CB

    Qualifications

    • Experience Minimum Required: 5 years of healthcare care experience and 3 years in managed care. Previous audit experience, knowledge of InterQual and Principals of Managed Care.
    •  Education Desired/Preferred: BSN or BA in Business Administration
    •  Training Minimum Required: Strong knowledge of state and federal laws and regulations, understanding of CMS coverage and payment methodologies
    • Special Skills Minimum Required: Excellent oral and written communication skills, Advanced computer proficiency, excellent organizational skills
    • Licensure Minimum: RN

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