Appeal and Audit Coordinator
St. Elizabeth's Medical Center - Boston, MA

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The Appeal & Audit Coordinator will manage all inpatient appeals for clinical denial of payment by medical record review, and input from Medical Staff, and Nurse Case Managers to generate a formal letter of appeal to the insurance carrier. In addition, the Appeal & Audit Coordinator will coordinate all external payor audits, and will be responsible for data collection, and opportunities for improvement in an effort to increase hospital reimbursement and decrease the rate of clinical denials. The Appeal and Audit coordinator will also assist with outpatient appeals as needed helping to establish processes for that department.

Minimum Education:

  • Bachelor of Science Degree
  • Current licensure in Massachusetts as a Registered Nurse preferred
  • Minimum Experience:

  • Five years experience in acute care setting
  • Knowledge of insurance regulations, and claims audit
  • Three to five years experience in managed care environment/benefits management
  • Three to five years experience in Quality, Utilization Review, and/or Case Management
  • Outstanding leadership and interpersonal skills
  • Excellent written skills
  • Effective verbal communication
  • Computer knowledge including data entry, and use of spread sheet

  • Steward Health Care - 18 months ago - save job - block
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