Non-Clinical Appeals Coord - Pennsylvania Hospital

Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Summary:

Responsible for coordinating office activities for the Clinical Appeals Coordinators to assist the department in accomplishing the goals and objectives which include ensuring the delivery of quality care that facilitates discharge and expected outcomes in a cost-effective and efficient manner. To also follow expected timelines for Federal and State audits and appeals.

Responsibilities:

• Demonstrates Professionalism within the framework of Relationship Based Care (Patient-Centered Care).

• Demonstrates Teamwork by displaying a cooperative relationship with co-workers by consistently treating others with respect and always using open and honest communication.

• Demonstrates Patient-Centered Care by showing courtesy, compassion, sensitivity and respect in all interactions with patients, visitors and other hospital personnel.

• Displays a cooperative attitude and responds with respect to directions and recommendations from supervisor.

• Supports ongoing improvement of client satisfaction:

• Returns phone calls and emails promptly

• Attends meetings as requested

• Is politically sensitive to clients/patients environment Is knowledgeable in their area

• Timeliness on completing projects

• Data provided is accurate and reliable

• Identify the competencies required for each patient population that the employee works with (neonate, child, adolescent, young adult, middle adult and older adult)

• Participates in Entity and Department wide initiatives for Patient /Employee safety

• Demonstrates an awareness of patient/ employee safety when carrying out daily responsibilities of their position.

• Participates in Entity and Department wide initiatives for Patient/Employee safety

• Demonstrates an awareness of patient/ employee safety when carrying out daily responsibilities of their position.

• Validation of annual competencies required for the position

• Coordinates activities of staff interaction with State and Federal regulatory agencies both on site and via telephone and/or mail.

• Functions as a primary facilitator for Medicare and Medicaid for the distribution of patient related information including the hospital database, reports and all denial and appeals correspondence.

• Maintains database for the department and the utilization management requirements for the hospital information system and within the department.

• Organizes and maintains document flow for the department data entry from admission through discharge and the appeal process if appropriate.

• Interacts with on-site nurse reviewers to provide required ID badges, Statement of Confidentiality, and continuity of communication.

• Supports the activities of the Clinical Appeals Coordinator in all phases of the Clinical Quality and Utilization Management functions including but not limited to data entry, obtaining and copying medical records and preparing correspondence as part of the appeal process.

• Collaborates and communicates with other PAH and UPHS departments to proved information ( i.e. financial class changes, admission/discharge date corrections, denial activity) necessary to accomplish the goals and objectives of the Clinical Resource Management Department and the organization.

• Orders office supplies and coordinates equipment upkeep for the department.

• Maintains current knowledge about review requirements for all federal, state and third party payer programs in order to function as a departmental resource.

• Performs any additional duties as required to maintain and achieve departmental and organizational goals.

Education or Equivalent Experience:

• High School Diploma required.

• Knowledge of medical terminology, Federal, State and 3rd party payers appeal process, and computer data entry preferred.

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

REQNUMBER: 214851