Appeals Manager Job in Bronx 10457, New York US

Bronx Lebanon Hospital Center Health Care System, a multi-facility community teaching and integrated Health Care System servicing approximately 964 beds in the Bronx is seeking an Appeals Manager

 

The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and electronic format.  Collaborate with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff. Develop a strong appeal letter that will result in the denial being overturned providing the hospital reimbursement for the care and services provided to the patient.    Assist the department’s leadership develop strategies for denial prevention, improved utilization management, documentation of medical necessity and identify patterns and trends to prepare education programs for the staff on identified deficiencies to best respond to all hospital denials notification and documentation efforts.  Provide timely tracking and trending of all denials and appeals, prepare weekly status reports, attend necessary meetings to assist the department attain its objective of managing denials and appeals.

 

Requirements:  BA /BSN, Registered Nurse with 3-5 years or more of experience in healthcare administrative management and services work. Excellent verbal and communication skills as a large part of the job requires telephone communication and interaction with healthcare agencies staff and medical directors, physicians, nurses, external agency executives and administrative leadership as well as hospital department leaders. Excellent computer skills, be willing to learn electronic medical record systems and data entry into an electronic database system.  On the job or formal training in certified case management, denial and appeals management from a business school in office management, professional trade association, or a closely related area is preferred.

 

Please send resumes to:  bjoseph@bronxleb.org , Bea Joseph, Bronx Lebanon Hospital Center, 1276 Fulton Avenue, 6th Floor, Bronx, New York, 10456, or fax to (718) 901-8041.

 

Bronx Lebanon Hospital Center Health Care System is an equal opportunity and Affirmative Action Employer.