Appeals Coordinator

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

The Appeals Coordinator essentially assists mailing personnel in achieving timely, accurate, and complete appeals mailing process. The Appeals Coordinator tracks all appeals and denials through the denials database. He/She creates records for new appeal requests, prepare electronic files, and file patient data upon receipt. He/She prioritizes work load to ensure that appeals are submitted timely.  The Appeals Coordinator will follow-up with HIM personnel to obtain records when required documentation is missing. He/She will ensure that once the required documentation is provided by HIM staff, it will be attached with appeal letter packet and mailed out.  The Appeals Coordinator will also be responsible for answering update requests from Business Office personnel either via phone or emails.  The Appeals Coordinator will further support the department needs providing feedback to management regarding trends or patterns, actively participating in departmental meetings, offering suggestions for improvement of processes as well as being receptive to suggestions. The Appeals Coordinator will assist with monthly and quarterly reports as needed. The Appeals Coordinator will also serve as the primary contact coordinating and maintaining the integrity of tracking commercial appeals and following other duties as assigned. 

Education and Work Experience

Required qualifications

1. High School Diploma or equivalent.

2. Good communication skills is required.

Preferred qualifications

1. Minimum one-year health information management experience in acute care setting highly preferred.

3. Knowledge of State and Federal regulatory requirements for medical staff documentation; preferred.

4. Computer data entry with 10-key, with accurate typing speed of 35 wpm; preferred.

6. Completion of a medical terminology course; preferred.

7. Background in business office or office training in the healthcare field; preferred.

Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $21.00 to $24.00. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf