Clinical Appeal Specialist LPN

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POST DATE 9/13/2016
END DATE 11/16/2016

HCA Healthcare Houston, TX

Houston, TX
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Entry Level (0 - 2 years)
Associates Degree


Job Code: 08948-123824


No Weekends

Job Summary Handles appeals requiring clinical input or interpretation

Key Responsibilities

* Monitor insurance denials by running appropriate reports and contacting insurance companies to resolve claims denied for clinical reasons

* Identify coding or clinical documentation issues and work to correct the errors in a timely manner

* Identify problem accounts and escalates as appropriate

* Update the patient account record to identify actions taken on the account

* Work with guarantors to secure payment on account balances outstanding for clinical reasons

* Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement"

* Other duties as assigned

Knowledge, Skills & Abilities

* Communication - communicates clearly and concisely, verbally and in writing

* Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations

* Interpersonal skills able to work effectively with other employees, patients and external parties

* PC skills demonstrates proficiency in Microsoft Office applications and others as required

* Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures and systems

* Basic skills able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately

* Clinical skills ability to read and interpret medical records


* Associate s Degree preferred


* At least one year case management experience required

Last Edited: 08/22/2016