This associate provides support to The Clinical Appeals Nurses. Clarifies and verifies details of government denials (Medicare and Medicaid) and managed care denials. Tracks denial information, appeal due dates, and provides necessary details to The Clinical Appeals Nurses. Assist in mailing out appeals in a timely fashion. Additional duties may include conduction of research of evidenced based articles and updating the Appeal Library. The LVN Coordinator must have a solid understanding of Milliman Care Guidelines (MCG), InterQual, and/or other relevant guidelines. Key Performance and trends related to denials/appeals will be reported to the facility.
Review governmental contractors response letter in comparison to the medical records
Communicates with facility regarding missing or insufficient medical documentation
Review medical documentation for adherence to Medicare guidelines relating to inpatient services (or other Medicare issues) and draft appropriate appeal letters based upon professional clinical opinion as to the medical necessity of the services provided
Research issues using federal or law, federal regulations, and relevant CMS policies
Mails out Appeal Letters in a timely manner
Completes data entry in the Denial database for tracking, trends, and analysis
Maintain Clinical Appeals Library and assist with obtaining additional references
Our Mission: WHY WE EXIST. To extend the healing ministry of Jesus Christ. Our Core Values: WHAT WE BELIEVE IN.DIGNITY Respect for the worth of every person, recognition and commitment to the value of diverse individuals and perspectives, and special concern for the poor and underserved. INTEGRITY Honesty, justice, and consistency in all relationships. EXCELLENCE High standards of service and per...formance. COMPASSION Service in a spirit of empathy, love, and concern. STEWARDSHIP Wise and just use of talents and resources in a collaborative manner.Our Vision: WHAT WE ARE STRIVING TO DO. CHRISTUS HEALTH, a Catholic health ministry, will be a leader, a partner and an advocate in the creation of innovative health and wellness solutions that improve the lives of individuals and communities so that all may experience God's healing presence and love. Our Name and Symbol:WHO WE ARE. CHRISTUS is Latin for "Christ," and proclaims publicly the core of our mission. OUR NAME choice also recognizes the heritage of our two congregational sponsors, the Sisters of Charity of the Incarnate Word in Houston and San Antonio. Jesus Christ is the Incarnate Word, the Word of God made flesh. It is, therefore, only fitting that it is in another form of His name that our health ministries are called together. OUR SYMBOL Reflects the healing ministry of Jesus Christ - a combination of a medical cross and a religious cross. The flowing banner on the cross is a common symbol of the risen Christ, while the royal purple signifies Christ. The flowing banner also conveys a sense of motion as we move forward into a new era of service to our communities.