Director of Clinical Appeals (MDS Coordinator, Nurse or Therapist)
Centers Health Care is actively seeking an experienced Director of Clinical Appeals to track and follow up on medical denials for our large healthcare organization, primarily focused within our skilled nursing facility division. This is a dynamic role, with many possibilities for growth and future opportunities within the organization.
- Initiate, coordinate, and follow through the process of all insurance denial appeals at every level; review all denials with direct report for plan/strategy for the appeal
- Write first, second, and third level insurance appeal letters
- Review and coordinate utilization issues related to denials from all payors - concurrently and retrospectively
- Maintain data tracking systems and identify Utilization trends
- Must possess the ability to review and comprehend all facets of a patient's medical chart
- Strong clinical knowledge and coding skills
- Direct clinical or related experience within the SNF/Long Term Care setting - Nursing or Therapist credentials and background required
- Preferred: working knowledge of reimbursement regulation and compliance in subacute and long term care setting
- 1+ year Case Management Experience preferred
- Preferred: Experience writing Medicare Redeterminations, Reconsiderations and attending ALJ Hearings
- Ability to perform independently and prioritize projects/assignments
- Ability to meet deadlines and handle related pressures
- Excellent verbal and written communication skills
- Strong computer skills
- Must have previous Nursing or Therapy experience. Previous MDS 3.0 experience preferred. Registered Nurse, Physical or Occupational Therapist.
Bronx, NY, (occasional travel required)
Centers Health Care is the only fully integrated post-acute continuum of care, offering services to the elderly throughout NY, NJ and RI through its Healthcare facilities & agencies, Dialysis & Urgent Care Centers, Ambulance & Ambulette Services, a Managed Care Plan and a Durable Medical Equipment Provider. Earning praiseworthy reviews as the leading provider of top quality medical care in rehabilitative treatment and healthcare, Centers Health Care is unwavering in our dedication to excellence in care, and proud of our commitment to diversity and community involvement.
Equal Opportunity Employer – M/F/D/V