Appeals Coordinator: Peer to Peer

📋 Description

• • CorroHealth, a leading physician-led organization dedicated to enhancing hospital financial performance, is seeking a highly motivated and detail-oriented Appeals Coordinator to join our dynamic Corro Clinical division. This remote role is crucial for navigating the complexities of the healthcare reimbursement cycle, ensuring our clients achieve their financial health goals through expert clinical and operational solutions. As an Appeals Coordinator, you will play a pivotal role in the appeals process, acting as a key liaison between CorroHealth, medical directors, and various payers. Your primary responsibility will be to facilitate and schedule "Peer to Peer" calls, a critical step in resolving claim denials and securing appropriate reimbursement for our hospital clients.
• • This position requires a significant portion of your day, approximately 90%, to be spent on the phone, engaging with payer representatives. You will be responsible for proactively contacting payers to schedule these vital Peer to Peer discussions with CorroHealth Medical Directors. This involves understanding payer protocols, identifying the correct contacts, and effectively communicating the necessity of these calls to ensure timely resolution of appeals.
• • Beyond scheduling, you will also be tasked with following up on cases where the Peer to Peer calls have exceeded their scheduled timeframe. This requires persistence, strong follow-up skills, and the ability to navigate payer systems and processes to keep appeals moving forward. Your diligence in these follow-up activities will directly contribute to minimizing revenue leakage and maximizing financial recovery for our clients.
• • Accurate and thorough documentation is paramount in this role. You will meticulously record information obtained during payer calls within CorroHealth's proprietary system. This includes details about the case, discussions held, agreements made, and any required next steps. Furthermore, you will be responsible for entering and updating account statuses across multiple databases, ensuring data integrity and providing a clear, up-to-date overview of the appeals process for each case.
• • The Appeals Coordinator will also provide essential support to various functions within the department. This includes assisting with case entry, providing crucial support for the Peer to Peer call process, and contributing to the broader appeals management efforts. Your versatility and willingness to support different areas will be highly valued and contribute to the overall efficiency of the team.
• • While this role requires you to work independently, managing your own schedule and caseload, it also demands strong collaboration and teamwork. You will be an integral part of a larger team, working closely with Medical Directors, other coordinators, and department leads to achieve collective goals. Effective communication and a shared commitment to client success are key.
• • The fast-paced nature of the healthcare revenue cycle means you must be adaptable and able to thrive in a dynamic environment. You will be expected to manage multiple tasks simultaneously, working across various screens and programs, requiring exceptional organizational skills and the ability to toggle efficiently between different applications and data sources.
• • Problem-solving is at the heart of this role. You will be actively involved in identifying and resolving issues that arise during the appeals process. A proactive approach, a desire to seek resolutions, and the initiative to take ownership of challenges will make you an ideal candidate. Your ability to think critically and find effective solutions will be essential for success.
• • Maintaining strict confidentiality of all client and sensitive information is non-negotiable. Adherence to HIPAA/HITECH compliance regulations is mandatory, ensuring the security and privacy of protected health information. This commitment to compliance is fundamental to our operations and client trust.
• • This role offers a unique opportunity to contribute directly to the financial health of hospitals, impacting the quality of care they can provide. You will be part of an innovative and growing company that invests in its employees' professional development and personal growth, fostering a positive work-life balance.