Appeals Coordinator

Overview

The Appeals Coordinator reviews all adverse decisions regarding continued stay and insures appropriate action is taken to maximize revenues for Kids Peace while maintaining the integrity and ethics of Kids Peace Corporation. The Appeals Coordinator also acts as a liaison between Kids Peace and external funding sources. The Appeals Coordinator functions as the point of contact for contracting needs of medical managed care companies for medical assistance.

• Prepare and coordinate specified denials for appeal/grievance with the appropriate managed care organization, including assurance that the client or the client’s guardian has signed the appropriate authorizations
• Complete appeal letter to be sent to the appropriate managed care organization and communicate with all parties throughout the appeals/grievance process
• Document and maintain the denials worksheet
• Ensure that the policies and procedures are being followed throughout the Kids Peace programs
• Serve as the liason/point person regarding any concerns/issues/problems between Kids Peace and managed care organizations and foster a positive working relationship between them
• Prepare and participate in chart audits, provider profiling and onsite visits by managed care organizations
• Coordinate contracting with medical assistance managed care organizations for the purposes of the provision and billing of medical services by Kids Peace physicians

• Bachelor's Degree in related field preferred;
  High School diploma and experience in related field required
• Experience with managed behavioral healthcare
• Knowledge of Federal and State laws related to the managed care industry