Clinical Appearls Coordinator-PT

Job Requisition ID R00049403 Job Category Nursing Organization Rev Cycle - Patient Access PAU Location Central Billing Office - Clinton Job Title Clinical Appearls Coordinator-PT Job Summary Coordinates and supports the billing process, including denial and appeal reviews. Evaluates and monitors patient care payment denials and related claims while supporting the development of strategies to minimize financial risk through effective appeals management. Conducts research, collaborates with departments to verify denials, performs clinical reviews, and prepares reports to support quality improvement initiatives and prevent future denials. Education & Experience Required Two (2) years of nursing experience. Certifications, Licenses, or Registration Required Valid RN license. Preferred Qualifications Utilization review and case management experience. 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 to support billing and appeals management, analysis, and monitoring activities. Communicates with insurers to determine the appropriateness of payments or denials. Collects, reviews, and submits timely appeals for medical necessity and authorization of denials. Conducts clinical research and analysis to identify issues and develop strategies that improve the payment and appeals process. Assists with chart audits by reviewing and comparing medical records against itemized patient bills to ensure accuracy and maintain revenue integrity. Analyzes denial and payment data to identify trends and patterns, supporting system‑wide performance improvement and management education. Supports quality improvement initiatives by reviewing clinical practices for consistency, adherence to policy, and appropriate levels of care across settings; prepares reports and communicates findings to clinical and non‑clinical staff. Communicates and negotiates with external stakeholders, including insurance payers, regarding appeal outcomes. Maintains knowledge of current regulatory and accreditation standards related to denial and appeals management to support organizational compliance. 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 off‑site 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 Part time FLSA Designation/Job Exempt No Pay Class Hourly FTE % 75 Work Shift Day Benefits Eligibility Grant Funded: No Job Posting Date 04/3/2026 Job Closing Date (open until filled if no date specified) #J-18808-Ljbffr