Clinical Appeals Specialist (LPN/LVN)
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POST DATE 9/13/2016
END DATE 11/2/2016
JOB DESCRIPTIONJob Code: 08950-114454
We serve and enable those who care for and improve human life in their communities.
Parallon, a division of HCA, is an industry-leading provider of patient financial and revenue cycle services to acute care providers across the United States. We are dedicated to our values and passionate about finding future leaders for our fast-growing divisions in the Dallas/Fort Worth area. Although we are the largest healthcare provider in the world and experts and leaders in revenue cycle services, we maintain a people-first culture and sense of community.
The Clinical Appeals Specialist handles appeals requiring clinical input or interpretation. Job tasks and responsibilities include:
* Monitors insurance denials by running appropriate reports and contacting insurance companies to resolve claims denied for clinical reasons
* Identifies coding or clinical documentation issues and works to correct them 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 or Vocational Degree in Nursing preferred but not required
* At least one year case management experience required; relevant education may substitute experience requirement
CERTIFICATE/LICENSE Current State RN or LPN License preferred
Last Edited: 04/05/2016