Envision a place where you thrive. Envision an organization that believes in you as much as you believe in them. A place where your work has meaning. At ADVENT, you can have just that.
ADVENT embraces those who seek more and demand excellence from themselves and their employer. We invite you to be challenged, to challenge, and to embark on a journey where passion meets purpose. We’re not what you typically find in healthcare. We’re proud to be a team that does things differently, with a focus on finding solutions for our patients. We know we’re not for everyone and don’t claim to be perfect but our commitment to improvement is unwavering. We have the tenacity, creativity, and drive to find a better way – together - and always keep our patients at the forefront.
Are you ready to rediscover your professional purpose? Take the leap and join us on your journey towards success.
How you will make an impact as a Denial & Appeal Management Coordinator:
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Reviews all denied prior authorizations and supporting documentation to determine if appeal should be initiated, initiate appeals and continue to escalate to the next level of appeal.
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Maintains a clinical appeal process for all inpatient denials assuring that proper documentation is provided to support appeals of unauthorized inpatient days or days denied for lack of documentation.
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Maintains a clinical appeal process for all outpatient prior authorization denials, i.e., outpatient prior authorization denials, radiology denials, HMO denials for specialty care where a referral was not obtained, and clinical documentation is required.
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Utilizes denial reports to assess root causes and identify trends along with opportunities. Share findings with stakeholders.
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Manage appeals through each level and escalate where needed to resolve. Work with highest level of appeal cases; Refer appropriate cases to Clinical Physician Director and Senior Operational Leadership and works closely with them on development of second level and external appeals
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Coordinates timely processing of all appeals at all levels, i.e., initial appeals, second level response, progress reports.
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Support co-workers and engage in positive interactions.
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Communicates in a manner consistent with positive patient relations and prompt and accurate reimbursement.
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Provides helpful assistance in anticipating and responding to the needs of our patients.
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Collaborates with patients and team members in planning and decision making to result in optimal solutions.
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Ability to stay calm under pressure and deal effectively with difficult people.
What we're looking for in a Denial & Appeal Management Coordinator:
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Minimum of a bachelor’s degree in Nursing, Healthcare Administration, or a related field
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Minimum of 3 plus years of clinical nursing experience
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3 years of relevant experience in commercial insurance prior authorization approval/denial management
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Knowledge of third-party payer reimbursement and denial management
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Experience with a healthcare software system including EMR (clinical and financial) is highly desired
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Practiced and refined relationship development skills
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Proficiency with technology, including the Microsoft Office suite and business reporting, Power BI, Excel, PowerPoint, CRM
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High emotional intelligence with a selfless mindset with a respectfully aggressive approach
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Excellent verbal and written communication skills
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Self-motivation, initiative, and decision-making skills
Why you should choose ADVENT:
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Culture that embraces being kind, is solutions minded, and encourages you to ask questions
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22 days of PTO (prorated your first year based on start date) & holiday pay
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Medical, dental, and vision insurance with generous employer paid HRA account
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401k contribution
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Hybrid work model
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