Appeals Coordinator (PRN) - Restore Corporate (Potential Remote Opportunity)

• High school diploma or equivalent required.
• Must be experienced working with computers, including Microsoft Windows/Office environment and using Microsoft Word, Excel, and Outlook.
• Must exhibit the ability to learn rehabilitative supportive documentation and general practices of therapy evaluations and treatment.
• Must be attentive to detail, accurate, thorough, and persistent in following through to completion of all activities, demonstrating initiative for completing work assignments.
• Effective customer service and communication skills.
• Willingness to work as part of a team, working with others to achieve goals, solve problems, and meet established organizational objectives.
• Must be able to perform the essential job functions with or without accommodations.

ESSENTIAL JOB FUNCTIONS:

• To gather and submit all therapy documentation and supportive therapy documentation of MRR’s and ADR’s for assigned states and/or facilities.
• To gather and submit all therapy documentation and supportive therapy documentation for appeal redetermination and reconsideration level denials for assigned states and/or facilities.
• To request fair hearing teleconferences for appeal reconsideration that are still denied for assigned states and/or facilities.
• To request Appeals Council reconsideration per written letter of appeal or all Administrative Law Judge hearing level claims still denied for assigned states and/or facilities.
• To maintain a database, which tracks notifications of MRR’s, denials, decision, etc., as well as tracks when information was mailed out, completed, etc.
• To generate a denial financial report for assigned states and/or facilities.
• To communicate with therapy staff, facility staff, facility corporate staff, and Restore Management staff on a regular basis.
• Maintain resident confidentiality in regards to medical records documentation.
• Performs other duties as assigned.