What are the responsibilities and job description for the Utilization Management and Appeals Coordinator position at MBOS, Inc?
Job Description:
We are looking for an International Medical Graduate with clinical experience to support our utilization management and appeals. This role is essential for ensuring the accurate review of medical records, determining medical necessity, and submitting appeals. The ideal candidate will have a clinical background, excellent communication skills, and prior experience with clinical documentation improvement (CDI) practices and revenue cycle process would be a plus.
This is an in-office position located in Hillside, IL.
*We are not a temp services company*
Key Responsibilities:
- Review and analyze medical records to determine the medical necessity of services provided.
- Prepare and submit appeals for denied claims.
- Utilize clinical criteria such as MCG (Milliman Care Guidelines) and InterQual to support decisions related to medical necessity.
- Collaborate with physicians, case managers, and other healthcare providers to ensure accurate documentation and proper coding.
- Work with a small team of case managers, ensuring efficient workflow and high-quality decision-making.
- Track and monitor appeal outcomes and identify trends in denials to improve processes.
- Generate regular reports on key performance indicators (KPIs) related to claims denials, appeals, and overall hospital trends.
Qualifications:
- International Medical Graduates with Clinical Experience
- Experience in clinical documentation improvement (CDI), medical necessity determination, and appeals management.
- Knowledge of MCG, InterQual, and other clinical guidelines.
- Experience in medical coding, reimbursement processes, and healthcare regulations.
- Strong communication, problem-solving, and organizational skills.
- Ability to lead a small team and collaborate effectively across departments.
- Proficiency in healthcare software systems and report generation.
Working Conditions:
- Full-time position.
- Office-based, may require hospital visits once/twice a month.
This position offers an opportunity to play a key role in improving hospital operations, ensuring proper documentation, and contributing to the overall success of the organization. If you are a dedicated and experienced professional, we encourage you to apply.
Job Types: Full-time, Part-time, Contract
Pay: $25.00 - $99.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
Salary : $25 - $99