Clinical Appeals Coordinator - Remote

Profile

Overview
Physician Affiliate Group of New York (PAGNY) is one of the largest multi-disciplinary groups in the country whose main purpose is to nurture and embolden the healthcare providers who take care of the most fragile and vulnerable patients in New York City. PAGNY people do more than diagnose and treat; we uplift the spirits and dignity of patients because we love what we do, and it shows. PAGNY is committed to recruiting and retaining productive and enthusiastic physicians and promotes our health professionals\u2019 wellness. 
PAGNY is comprised of over 4,000 physicians and healthcare professionals who provide services to NYC Health Hospitals (H H), the largest public health system in the United States.  Our practitioners are highly skilled professionals with outstanding credentials who deliver the highest level of quality healthcare to patients throughout New York City.    
NYC Health Hospitals/Lincoln, located just 15 minutes from NYC, is an acute care teaching hospital academically affiliated with Weill-Cornell Medical College.  Dedicated to providing high quality patient care to a diverse community, Lincoln Medical Center is a NYS designated Level I Trauma and Stroke Center and has Centers of Excellence in all medical specialties including its award- winning Cancer and Breast Centers.  
 
PAGNY has a strong commitment to the principles of diversity and, in that spirit, actively encourages applications from groups underrepresented in healthcare. 
Responsibilities
We are currently seeking for a Clinical Appeals Coordinator responsabilities are as follow but not limeted to:

Determines actions required for all levels of appeals within contractual timeframes.
Monitors inpatient denial types, volumes, and formulates responses to requesting agency and seeks additional resources as needed to resolve issues.
Collaborates and consults with physician/physician advisor. Utilize clinical skills to identify documentation opportunities to reflect appropriate severity of illness, acuity and resource consumption and facilitate optimal revenue enhancement, where appropriate.
Propose principal diagnosis, co-morbid conditions, complications, and procedures and appropriate working DRG (diagnostic related group) and SOI (severity of illness).
Generates denials reporting and tracking data. Participate in performance improvement activities; data collection, tracking, trending and reporting.
Analyzes denial report and trends to proactively identify opportunities for quality improvement.
Conduct educational in-services for medical staff; attend and participate in educational in-services.
Maintain positive and open communications with physicians, interdisciplinary care team members, coding staff, coding compliance management team and department director.
Review Clinical Denials Epic Work Queues
Generate Monthly Statistical Reports.
Performs other activities as required.

Schedule: Monday to Friday - 9am-5pm ( REMOTE opportunity. )
Qualifications

MD (Foreign MD candidates are welcome)
OR
RN license required with minimum of 3-5 years\u2019 experience as staff nurse in an acute care facility; Case Management or Utilization Management experience with ability to work with coding techniques preferred.
Must consistently demonstrate tact, diplomacy and possess strong interpersonal skills to gain cooperation and support.

Benefits include: 

Competitive compensation package 
10% 401K company contribution after one year of service 
Choice of a three-tiered nearly FREE medical plan 
Excellent dental insurance including orthodontics coverage 
Generous paid time off program 

Salary Amount: $93,000

Equal Opportunity Employer M/F/D/V 

Company info

Physician Affiliate Group of New York, P.C