One of the nation's largest and most respected hospital companies, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Steadily growing from a startup to an esteemed Fortune 500 corporation, UHS today has annual revenue nearing $10 billion. In 2017, UHS was recognized as one of the World's Most Admired Companies by Fortune; ranked #276 on the Fortune 500, and listed #275 in Forbes inaugural ranking of America's Top 500 Public Companies.
Our operating philosophy is as effective today as it was 40 years ago: Build or acquire high quality hospitals in rapidly growing markets, invest in the people and equipment needed to allow each facility to thrive, and become the leading healthcare provider in each community we serve.
Headquartered in King of Prussia, PA, UHS has more than 81,000 employees and through its subsidiaries operates more than 320 acute care hospitals, behavioral health facilities and ambulatory centers in the United States, Puerto Rico, the U.S. Virgin Islands and the United Kingdom.
The Atlantic Region CBO is seeking a dynamic and talented team member with clinical case management experience to support appeals of denial admissions and outpatient service.
Key Responsibilities include:
1. Analyze trends in insurance denials and work with insurance companies to implement ways to resolve underlying reasons for denials.
2. Manage recurring coding or clinical documentation issues and correct the underlying causes for error.
3. Use discretion, knowledge and independent judgment to resolve escalated Clinical Appeals issues.
4. Work as a liaison between Clinical Appeals and other departments to conduct billing and charging compliance in accordance with applicable Federal and State laws.
5. Perform QA for Clinical Appeals function.
6. Perform insurance defense audits as requested.
7. Consistently demonstrates HIPAA compliance with regard to patients' protected health information.
8. Provides clinical knowledge for CBO staff and consultation to management as needed.
9. Manage daily activities related to the CBO's Clinical Appeals function; ensuring processes are performed efficiently and effectively.