Clinical Appeals Coordinator - Pre Authorization at University of Mississippi Medical Center

, , United States -

Full Time

Start Date

Immediate

Expiry Date

07 Feb, 26

Salary

0.0

Posted On

09 Nov, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Review, Data Collection, Communication, Problem Solving, Interpersonal Skills, Decision Making, Quality Improvement, Utilization Review, Case Management, Billing Process, Appeals Management, Regulatory Compliance, Research, Analysis, Customer Service, Negotiation

Industry

Hospitals and Health Care

Description

Hello, Thank you for your interest in career opportunities with the University of Mississippi Medical Center. Please review the following instructions prior to submitting your job application: Provide all of your employment history, education, and licenses/certifications/registrations. You will be unable to modify your application after you have submitted it. You must meet all of the job requirements at the time of submitting the application. You can only apply one time to a job requisition. Once you start the application process you cannot save your work. Please ensure you have all required attachment(s) available to complete your application before you begin the process. Applications must be submitted prior to the close of the recruitment. Once recruitment has closed, applications will no longer be accepted. After you apply, we will review your qualifications and contact you if your application is among the most highly qualified. Due to the large volume of applications, we are unable to individually respond to all applicants. You may check the status of your application via your Candidate Profile. Thank you, Human Resources Important Applications Instructions: Please complete this application in entirety by providing all of your work experience, education and certifications/ license. You will be unable to edit/add/change your application once it is submitted. Job Requisition ID: R00045678 Job Category: Nursing Organization: Rev Cycle - Patient Access PAU Location/s: Main Campus Jackson Job Title: Clinical Appeals Coordinator - Pre Authorization Job Summary: To provide coordination and support of university hospitals and health system /university physician billing process and the denials and appeals review process. To participate in the review, evaluation, monitoring, measuring and adjustment of all patient care payments denials and associated claims; participates in the development of risk minimization appeals program. Conducts research including departmental interviews/communication for verification of denial, clinical review of the denial, and conducts a reporting process for quality improvement initiatives to prevent future issues. Education & Experience Associates degree in nursing (ADN) plus five (5) years of clinical nursing experience or a Bachelors in a nursing plus three (3) years of clinical nursing experience. Utilization review and/or case management is preferred. Certifications, Licenses or Registration Required: Valid RN license. Knowledge, Skills & Abilities Knowledge and understanding of clinical organization structure, workflow, and operating procedures. Skill in the use of personal computers and related software applications. Ability to manage multiple priorities under time constraints; ability to analyze and solve problems. Understanding cost and quality issues. Verbal and written communication skills. Interpersonal skills to interact with a wide range of constituencies. Decision-making skills. Responsibilities Reviews patient medical records and collects data for billing and/or appeals process management, analysis, studies, and monitoring. Communicates with insurer to determine if payments/denials are appropriate. Collect, review and perform timely appeals on medical necessity denials and/or authorization denials. Conducts clinical research and analyses and prepares reports as required; anticipates and identifies issues in order to develop strategies and solutions in the payment and appeals process. Assist as needed with chart audits, reviewing and comparing the medical records against the patient's itemized bill to ensure complete and accurate revenue integrity. Participates in planning system-wide measurement initiatives with respect to assessment and management of accounts to determine patterns and trends of payment and/or denials and facilitates communication to improve performance and educate management. Assists in the review of clinical practice for quality improvement and loss control; recommends appropriate corrective action; reviews for consistency, adherence to policy and comparative level of care in all settings; inputs data and prepares reports. Communicates with clinical and non-clinical staff all findings. Communicates and negotiates with external stakeholders. Maintains an understanding of current TJC standards pertaining to denial and appeals management; assists the university hospitals and health system to maintain compliance with regulatory standards, federal and local as it pertains to denial of claims. Provides timely internal/external customer service in a cooperative, professional, and respectful manner. The duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time. Physical and Environmental Demands Requires occasional exposure to unpleasant or disagreeable physical environment such as high noise level and exposure to heat and cold, occasional exposure to bio-hazardous conditions such as risk of radiation exposure, blood borne pathogens, fumes or airborne particles, and/or toxic or caustic chemicals which mandate attention to safety considerations, occasional working hours significantly beyond regularly scheduled hours, occasional travelling to offsite locations, occasional work produced subject to precise measures of quantity and quality, occasional bending, occasional lifting and carrying up to 25 pounds, occasional crouching/stooping, occasional kneeling, occasional pushing/pulling, frequent reaching, frequent sitting, frequent standing, occasional twisting, and frequent walking. (occasional-up to 20%, frequent-from 21% to 50%, constant-51% or more) Time Type: Full time FLSA Designation/Job Exempt: Yes Pay Class: Salary FTE %: 100 Work Shift: Benefits Eligibility: Grant Funded: Job Posting Date: 11/6/2025 Job Closing Date (open until filled if no date specified): The University of Mississippi Medical Center is committed to educating the next generation of health professionals, discovering new cures and treatments and providing the highest quality health care. We foster environments that support respect, compassion and belonging for all faculty, staff and students as well as patients and visitors. Our employment, academic, research and clinical care practices reflect these commitments. UMMC is an equal opportunity employer and prohibits discrimination and harassment on the basis of race, color, national origin (including limited English proficiency and primary language), disability, age, sex (as that term is defined in applicable laws such as 45 CFR § 92.101(a)(2) and binding court decisions), religion, genetic information, veteran’s status and any other status protected by applicable law. UMMC also prohibits retaliation against those who report discrimination or harassment and against those who participate in the Medical Center’s investigation and handling of such reports. Further, UMMC complies with all applicable statutes, regulations and executive orders regarding sex discrimination, sexual harassment, domestic and dating violence, sexual assault and stalking, including but not limited to Title IX of the Education Amendments of 1972 and its implementing regulations which prohibit discrimination on the basis of sex in any education program or activity UMMC operates including in admission and employment, the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistic Act (“Clery Act”) and the Campus Sexual Violence Elimination Act (“SaVE Act”). UMMC’s commitment to nondiscrimination applies to all of its programs, services, opportunities and activities, including but not limited to all employment, academic, research and clinical care practices and extends to all students, applicants for admission, employees, applicants for employment, affiliates, subcontractors, on-site contractual staff, third party or community members, visitors to any of our campuses and others participating in UMMC programs or receiving UMMC services. With respect to employment in particular, this commitment applies to all employment decisions including but not limited to recruitment, employment, training, promotion, compensation, benefits, disciplinary actions and termination. UMMC maintains an affirmative action program in accordance with applicable laws. Consistent with these laws, UMMC takes affirmative action to recruit, employ, advance and prevent discrimination against qualified individuals. For additional information, please check here: Know Your Rights: Workplace discrimination is illegal (eeoc.gov). In compliance with Section 1557 of the Patient Protection and Affordable Care Act and other federal civil rights laws and to ensure individuals with disabilities and those with limited English proficiency have meaningful access to, have an equal opportunity to participate in and have an equal opportunity to enjoy the benefits of our programs, activities, services and other benefits, UMMC provides the following in a timely manner and free of charge: reasonable modifications to our policies, practices, or procedures for qualified individuals with disabilities when such modifications are necessary to avoid discrimination on the basis of disability; appropriate auxiliary aids and services for individuals with disabilities (including individuals’ companions with disabilities) which may include qualified sign language interpreters and written information in other formats including braille and large print and language assistance services for individuals with limited English proficiency (including individuals’ companions with limited English proficiency) which may include qualified interpreters and information written in other languages. Complaint Process You may request additional information, accommodation or file a complaint through the applicable process identified below. Inquires or complaints relating to discrimination or other employment issues may be referred to the Office of Employee Relations, 2500 North State Street, Jackson, Mississippi 39216-4505 or emailed to hremployeerelations@umc.edu. If you are a UMMC Student who needs more information or needs to file a complaint, please click here. You may also report any allegations of UMMC’s noncompliance with any legal requirement using UMMC’s Compliance Line. If you are anyone who has experienced, witnessed or otherwise has knowledge of any alleged violation of UMMC’s Title IX policy, please click here. If you are a Visitor/Patient who needs more information or needs to file a complaint, please click here. Finding the perfect job can take time and we want to make your search easier. If you didn't find a position that matches your interests today, we encourage you to create a job alert. By setting up a job alert, you'll receive notifications about new job openings that match your preferences as soon as they become available. To create a job alert, simply visit our careers page, log in or create an account, and set your job preferences. You can choose the job titles, locations, and departments you're interested in, and we'll keep you informed about relevant opportunities. We look forward to helping you find the right role with us!

Responsibilities

The Clinical Appeals Coordinator provides coordination and support for the billing process and the denials and appeals review process. This role involves reviewing patient medical records, communicating with insurers, and conducting clinical research to improve payment and appeals processes.