Job Description

APPEALS COORDINATOR

HO751, 752

The Appeals Coordinator is responsible for denial, appeal, and retro chart submission and tracking for all Landmark Recovery facilities and providers. Individuals that typically thrive in the role have a high level of organization, excellent written and verbal communication skills, attention to detail, inductive reasoning skills, and take an analytical and process-oriented approach to recognizing and solving problems.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Monitor and work all denials, appeals, and retro chart reviews as assigned
Compile and organize clinical documentation to support appeal submission
Draft necessary correspondence to payer sources
Properly track and document all denial and appeal activity
Maintain appeal log in required timeframe
Review and analyze trends related to denials, appeals, and retro chart reviews
Communicate appeal status updates to all necessary departments daily
Maintain working knowledge of all payer guidelines and requirements as they relate to denials, appeals, and retro chart reviews
Assist Utilization Review team and Revenue Cycle Management team to resolve any payer relations problems as needed
SUPERVISORY RESPONSIBILITIES:

None
COMPETENCIES - To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

Intellectual

Analytical, detailed-oriented, and process-oriented mindset
Ability to utilize inductive reasoning skills
Ability to read, analyze, and interpret common scientific and technical journals
Ability to write forms and other documents that conform to prescribed style and format
Ability to synthesize large amounts of information into documents that can easily be interpreted by others
Interpersonal

Excellent communication skills both verbal and non-verbal
Must be able to work with a wide-variety of individuals with different backgrounds
Demonstrated track record of collaboration and strong working relationships across departments
Leadership

Successfully coordinate across multiple parties both internally and externally.
Organization

Able to track multiple cases simultaneously
Keep a detailed and accurate list of cases including current status
Able to provide an accurate and holistic view of a situation
Self Management

Maintain self-organization and prioritize tasks appropriately
Able to stay on task with little supervision
Language, Math and Reasoning

Excellent communication skills and grammar
Ability to write emails and memos in a concise manner that are easy to read
Inductive reasoning to form conclusions based on established knowledge
EDUCATION, EXPERIENCE, and TRAINING:

High School diploma and/or equivalent education, bachelors degree in behavioral health related field preferred
Minimum of one year experience in healthcare setting
Must be committed to drug-free lifestyle and responsible alcohol use
Personal passion or interest in substance abuse issues strongly preferred
CERTIFICATES, LICENSES, REGISTRATIONS:

None required
COMPUTER SKILLS:

Microsoft O365 proficiency is required
PHYSICAL DEMANDS - The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The employee must occasionally lift and /or move up to 25 pounds.
While performing the duties of this job, the employee is regularly required to sit; talk; hear.
While performing the duties of this job, the employee is frequently required to reach with hands and arms.
While performing the duties of this job, the employee is occasionally required to stand; walk; use hands to finger, handle, or feel.
VISION REQUIREMENTS

There are no special vision requirements.
WORK ENVIRONMENT - The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

This position works in an environment with moderate noise level. (Examples: business office with computers and printers, light traffic.)

Education

• High School or better