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UTILIZATION AND APPEALS COORDINATOR

City:  Norwood
State:  OH
Job Requisition Number:  179953

Attention current TriHealth employees:

Please apply for this position by submitting an online internal application via SuccessFactors. Please be certain to update your SuccessFactors Employee Profile prior to applying to this position.

UTILIZATION AND APPEALS COORDINATOR: This position may perform utilization management functions on a prospective, concurrent or retrospective basis in order to maximize revenue for TriHealth. This includes analysis of clinical information presented with comparison to established national clinical criteria to determine appropriate place of service such as inpatient/outpatient/observation and medical necessity for ongoing inpatient care. In addition, understands all government and health plan requirements while negotiating with health plan to obtain authorization for services or payment on denied claims. This staff works independently with a high level of autonomy and decision making surrounding high dollar services and revenue.

MINIMUM REQUIREMENTS:

EDUCATION: Associate's Degree or Diploma in Nursing New hires required to obtain BSN within 5 years of hire. Registered Nurse Current Ohio licensure

EXPERIENCE: 5-7 years Clinical in Nursing hospital based

SPECIALIZED KNOWLEDGE: .

Word, Excel, exceptional written and oral communication skills.

Job Title:  UTILIZATION AND APPEALS COORDINATOR

Department Name:  TRIS PATIENT ACCOUNTING

Location:  Norwood

Hourly/Salaried:  Salaried

Employment Status: Full Time Position

Bi-Weekly Hours:80

Shift: Day Shift

Weekend Commitment:  No

Holiday Commitment:  No

On-Call Commitment:  No


Nearest Major Market: Cincinnati

Job Segment: Medical, Nursing, Registered Nurse, Healthcare