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Appeal & Audit Coordinator

Profession Specialty City State Position ID
Nursing Registered Nurse Westwood MA 162980
Job Description

We are seeking a qualified individual for a full-time permanent opening in Greater Boston.

Responsibilities

  • Compose appeal letters for inpatient admission and inpatient/outpatient denials
  • Submit appeal packet to denying insurer and second level of appeal as needed
  • Appeal all external payer audits through chart review analysis and data collection 
  • Implement the appeal process through analysis and review of medical records
  • Work with HIM to attain medical records
  • Manage cases using an internal tracking system and collaborate with case management and attending physician
  • Monitor payer or operational issues on denial/appeal summary, outpatient denial summary, and audit summary
  • Verify payments by using billing system
  • Consult with leadership and other departments to obtain documentation to support appeal
  • Identify trends and monitor audit activity
  • Participate in on-site audit process

Requirements
  • Bachelor of Science Degree or a licensed registered nurse with equivalent relevant experience
  • 5 years experience in acute care setting
  • 3-5 years experience in managed care environment/benefits management
  • 3-5 years experience in Quality, Utilization Review, and/or Case Management
  • Knowledge of insurance state and federal regulations
  • Knowledge of the claims audit process
  • Leadership skills
  • RN license
  • InterQual experience strongly preferred
  • Computer proficient
To learn more about this exciting opportunity, please apply directly to this post, send your resume to cchu@crosscountry.com.

CBDR

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