Case Manager Appeals Coordinator - RN

The Case Manager Appeals Coordinator is responsible for ensuring that Trinity Health receives appropriate payment for delivered services. The position is expected to review, research, and resolve payment denials for all payers. The specialist is accountable for carrying out and documenting appeals, adjudicating claims as appropriate, conducting formal account reviews, helping to identify root causes of denials, and working with internal and external resources to resolve any root cause issues. Knowledge of state/federal laws that relate to contracts and to the appeal process is vital.

 

Position Requirements:

Minimum Education:

Required: Bachelors Degree

Preferred: Masters Degree

Specify Degree(s): Nursing

Residency: N/A

Minimum Experience:

Details: Two or more years of clinical nursing experience preferred • Medical chart auditing

experience required • Experience as a Nurse Auditor or in a Case Management department

preferred • Must possess a personal presence that is characterized by a sense of honesty,

integrity, and caring with the ability to inspire and motivate others to promote the philosophy,

mission, vision, goals, and values of Trinity Health

Managerial Experience: N/A

Licensure/Certifications:

Required:

Current Registered Nurse License State of Illinois

Preferred:

Specialty certification in clinical or functional area of nursing granted by a national nursing

organization.

Other: Case Management certification preferred.