Denials Care Coordinator

Why naviHealth?

naviHealth is the result of over a decade of dedicated visionary leaders and innovative organizations challenging the status quo for PAC management solutions. We do healthcare differently and we are changing healthcare one patient at a time. How might you ask? By hiring talented clinicians, engineers, developers, and healthcare leaders to create and utilize cutting edge technology in order to provide the patient with the best level of care for the right amount of time.

Why Is This Role Critical? 

Denials Care Coordinator ensures timely processing of all denial related and member oriented written communications from naviHealth.  He/she ensures that all denial information is processed according to protocol and that all documentation is timely and meets all Federal and State requirements.  In addition, he/she will follow established facility policies and procedures.

What you will be accountable for….

  • Ensures second level reviews have been performed and documented and may confer with medical directors, UM manager(s), inpatient care coordinators, SNF Care coordinators and facility personnel in determining denial information is processed timely and appropriately. 
  • Utilizes naviHealth proprietary technology for consideration of level of care.
  • Maintains UM/CM tool
  • Serves as a liaison with regards to communicating to payers, providers, members, Quality organizations and other naviHealth colleagues.
  • Coordinate/prints/mails/faxes denial letters, NOMNC, DENC when indicated.
  • Acts as a point person for QIO appeals.
  • Serves as a liaison for requests for information from QIO or health plan staff.

What you will need to be successful in this role….

  • Current Licensure as a Physical Therapist (PT), Registered Nurse (RN), Licensed Practical Nurse (LPN), Licensed Vocational Nurse (LVN), Physical Therapy Assistant (PTA), or Certified Occupational Therapy Assistant (COTA).
  • At least three years experience in an acute care, managed care or social services environment.  
  • Strong technical/computer skills
  • Excellent documentation skills required.
  • Self-starter with the ability to prioritize daily work load.
  • Strong inte rpersonal and communication skills (both verbal and written).

The nice-to-haves……

  • At least two years recent experience in case-management or utilization management. 
  • Five years recent experience in an acute care, rehab or skilled nursing facility environment.
  • Managed care experience a plus.
  • ICD-9 and InterQual experience a plus.
  • CMS knowledge preferred.

About naviHealth

NaviHealth is a pioneer in care transitions with a combined unprecedented 16 years of experience that uniquely positions us to manage and share risk with our partners.  As a Cardinal Health company, we provide clinical support alongside scaled technology and advisory solutions that empower health systems, health plans, and post acute providers to navigate care episodes across the continuum, with the goal of reducing waste and improving patient outcomes

naviHealth ™ is proud to be an equal opportunity/affirmative action employer. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce